Types and Characteristics of Urban and Peri-Urban Blue Spaces Having an Impact on Human 3 Mental Health and Wellbeing

1 Types and characteristics of urban and peri-urban blue spaces 2 having an impact on human mental health and wellbeing

3 4 A report of the EKLIPSE Expert Working Group on Biodiversity and Mental Health 5 to provide recommendations for the conservation, planning, design, and 6 management of urban green and blue infrastructures

7 Femke Beute1, Zoe Davies2, Sjerp de Vries3, Julie Glanville4, Hans Keune5, Annamaria 8 Lammel6, Barbara Livoreil7, Melissa Marselle8, Liz O’Brien9, Agnieszka Olszewska- 9 Guizzo10, Roy Remmen5, Alessio Russo11, Maria Beatrice Andreucci12 10 11 1 LightGreen Wellbeing, Kolding, Denmark & Faculty of Spatial Planning, University of Groningen, 12 The Netherlands 13 2 Durrell Institute of Conservation and Ecology (DICE), School of Anthropology and Conservation, 14 University of Kent, United Kingdom 15 3 Wageningen University & Research, Wageningen Environmental Research, the Netherlands 16 4 York Health Economics Consortium, York, United Kingdom 17 5 University of Antwerp, Belgium 18 6 Université Paris 8 Vincennes-Saint-Denis, Laboratoire Paragraphe, France 19 7 Fondation pour la Recherche sur la Biodiversité, France 20 8 German Centre for Integrative Biodiversity Research, Germany 21 9 Forest Research, Social and Economic Research Group, United Kingdom 22 10 NeuroLandscape Foundation, Poland & National University of Singapore, Yong Loo Lin School of 23 Medicine, Singapore 24 11 School of Arts, University of Gloucestershire, Cheltenham, United Kingdom 25 12 Department of Planning, Design, Technology of Architecture, and Faculty of Architecture, 26 Sapienza University of Rome, Italy

28 For further information about this report, please contact: [email protected]

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1 Contents

2 Types and characteristics of urban and peri-urban blue spaces having an impact on human 3 mental health and wellbeing ...... 1 4 1. Report Summary ...... 7 5 2. Background ...... 9 6 Aims and objectives ...... 9 7 The request ...... 9 8 The expert working group ...... 9 9 Theoretical framework: Blue space and mental health and wellbeing ...... 10 10 3. Method ...... 12 11 3.1 Literature search...... 12 12 Search strategy...... 12 13 Eligibility ...... 13 14 Population ...... 13 15 Intervention ...... 13 16 Exposure ...... 13 17 Comparison ...... 14 18 Outcome ...... 14 19 Record selection ...... 14 20 3.2 Meta-data extraction ...... 15 21 3.3 Critical Appraisal...... 15 22 Experimental ...... 16 23 Cross-sectional ...... 16 24 Qualitative ...... 16 25 3.4 Synthesis ...... 23 26 4. Outcomes ...... 24 27 4.1 Search outcomes ...... 24 28 4.2 Critical Appraisal...... 32 29 Experimental ...... 32 30 Cross-sectional ...... 33 31 Qualitative ...... 35 32 4.3 Synthesis ...... 36 33 Descriptive synthesis ...... 36 34 Experimental ...... 37 35 Cross-sectional ...... 38

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1 Qualitative ...... 39 2 Narrative synthesis ...... 39 3 Experimental ...... 39 4 Cross-sectional ...... 40 5 Qualitative ...... 41 6 5. Discussion ...... 43 7 5.1 Mental health benefits ...... 43 8 5.2 Blue space typologies ...... 43 9 5.3 Confidence of no bias for the included studies ...... 43 10 5.4 Differential effects coast versus inland waters ...... 44 11 5.5 Pathways from blue space to mental health ...... 45 12 5.6 Limitations ...... 45 13 6. Concluding remarks ...... 46 14 7. References ...... 47 15

16 Appendix A: (use Heading 1 – Appendices style) ...... 49 17

18 List of Figures

19 Figure 1. Proposed pathways for the mental health benefits of blue space……………………………………….9 20 Figure 2. The PRISMA Flowchart for the study selection…………………………………………………………………..23 21 Figure 3. Overall score (confidence of no bias) per item on the critical appraisal for the experimental 22 studies………………………………………………………………………………………………………………………………………30 23 Figure 4. Overall score (confidence of no bias) per item on the critical appraisal for the cross-sectional 24 studies……………………………………………………………………………………………………………………………………...33 25 Figure 5. Overall score (confidence of no bias) per item on the critical appraisal for the qualitative 26 studies………………………………………………………………………………………………………………………………………33 27 Figure 6. Distribution of studies over the blue space categories, per study type………………………………35

28 List of Tables

29 Table 1. Overview of the information extracted during the meta-data phase……………………………….….13 30 Table 2. Critical appraisal items for the experimental studies………………………………………………………15-17 31 Table 3. Critical appraisal items for the cross-sectional studies…………………………………………………...18-19 32 Table 4. Critical appraisal items for the qualitative studies……………………………………………………………….20 33 Table 5. Literature search results………………………………………………………………………………………………………22 34 Table 6. Overview of the included studies; experimental…………………………………………………………….24-25 35 Table 7. Overview of the included studies; cross-sectional………………………………………………………….26-27 36 Table 8. Overview of the included studies; qualitative………………………………………………………………..28-29

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1 Table 9. Confidence of no bias for the individual experimental studies…………………………………………….31 2 Table 10. Confidence of no bias for the individual cross-sectional studies……………………………………….32 3 Table 11. Confidence of no bias for the individual qualitative studies……………………………………………..34 4

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1 Types and characteristics of urban and peri-urban blue spaces having 2 an impact on human mental health and wellbeing

3 Femke Beute, Zoe Davies, Sjerp de Vries, Julie Glanville, Hans Keune, Annamaria Lammel, Barbara 4 Livoreil7, Melissa Marselle, Liz O’Brien, Agnieszka Olszewska-Guizzo, Roy Remmen, Alessio Russo, 5 Maria Beatrice Andreucci

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1 Glossary

Term Definition Reference

Blue space “Outdoor environments—either natural or manmade— Grellier et al., 2017, p. 3 that prominently feature water and are accessible to humans either proximally (being in, on or near water) or distally/virtually (being able to see, hear or otherwise sense water).”

Green space Outdoor environments dominated by vegetation, such as Adapted from Taylor et al., urban parks. 2017

Mental “A state of well-being in which every individual realizes his WHO, 2014 Health or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”

Mental “The psychological, cognitive and emotional quality of a Linton et al., 2016, p. 12 Wellbeing person’s life. This includes the thoughts and feelings that individuals have about the state of their life, and a person’s experience of happiness.”

Urban Relating to a city or town. Oxford dictionary

Peri-urban An area directly adjacent to a city or a town. Oxford dictionary

Ecosystem Ecosystems are the planet’s life supporting systems and MEA, 2005 services include the need for food, water, clean air, shelter, and relative climate constancy. Other health benefits include those derived from having a full complement of species, intact watersheds, climate regulation, and genetic diversity.

Salutogenic Health-promoting effects, as opposed to pathogenic or effects detrimental health effects.

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1 1. Report Summary

2 Urbanization is increasingly putting pressure on ecosystems and ecosystem services. Some evidence 3 has shown that green and blue spaces can support the mental health of urban residents. Policy 4 makers, city planners, other decision makers and land managers now face a major challenge to 5 maintain and enhance natural areas and characteristics. Knowing which types and characteristics of 6 green and blue space are beneficial for mental health is necessary to inform planning and 7 management decisions.

8 EKLIPSE received a request from the Ministry in charge of the Environment of France (MTES) to 9 review: “Which types of urban and peri-urban green and blue spaces, and which characteristics of 10 such spaces, have a significant impact on human mental health and wellbeing?”. A call for expertise 11 was issued in March 2017. After a preliminary scoping, it was decided to perform two systematic 12 reviews assessing the specific types and characteristics of blue space (review 1) and green space 13 (review 2) on mental health and wellbeing. The systematic searches were supported and conducted 14 by an experienced team of librarians, made possible by the financial support of the WHO. This report 15 presents the systematic review for blue space (Review 1).

16 A number of previous (systematic) reviews have focused on the effects of the amount and availability 17 of blue spaces on mental health and wellbeing (Britton, Kindermann, Domegan, & Carlin, 2018; 18 Gascon et al., 2017; Völker & Kistemann, 2011). These reviews point at positive associations of blue 19 space with mental health. The salutogenic effects of blue space have been proposed via three 20 pathways (Gascon et al., 2017; Nutsford, Pearson, Kingham, & Reitsma, 2016; White, Alcock, 21 Wheeler, & Depledge, 2013): 1) improved social interaction, 2) increased physical activity, and 3) 22 stress-reduction. Despite positive associations found between blue space exposure and mental 23 health, these reviews also claim a need for more research (Britton et al., 2018; Gascon et al., 2017; 24 Völker & Kistemann, 2011). From a theoretical point of view, the need to know which features (or 25 elements) of blue (and green) spaces are beneficial for mental health has also been expressed (e.g., 26 Bratman et al., 2019). To our knowledge, none of the existing reviews have distinguished mental 27 health benefits of specific types or characteristics of blue spaces.

28 This systematic review was performed according to the PRISMA guidelines (Moher, Liberati, Tetzlaff, 29 Altman, & Group, 2010). In November 2018, a literature search was performed using Ovid MEDLINE, 30 Web of Science, and Scopus, as well as through a focused investigation in the Journal of Landscape 31 and Urban Planning, initially yielding 22.755 unique (i.e., deduplicated) papers.

32 Eligibility screening was performed employing the PICO (Population, Intervention, Comparison, and 33 Outcome; Higgins & Green, 2011) / PECO (Population, Exposure, Comparison, and Outcome) 34 approach (see section 2.1.2 for further explanations). No restrictions were made in terms of 35 population. Eligible blue space interventions included those that changed the physical environment, 36 either by targeting its characteristics or habitat type. Studies looking at dose effects of a specific 37 characteristics or habitat type were also deemed eligible (e.g., cross-sectional studies looking at 38 effects of amount of freshwater surrounding the residential area on mental health or wellbeing). 39 Studies employing a compound measure of blue space (e.g., freshwater and coast taken together), 40 performed indoors, or without a comparator (i.e., a control group, urban environments, green

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1 environments, or other blue environments / characteristics) were excluded, as were studies looking 2 only at therapeutic interventions (aimed at the individual rather than the physical environment). We 3 did not exclude studies performed in rural areas as exposure to blue space in these environments 4 may also inform about effects of these particular blue spaces in urban or peri-urban areas. A wide 5 range of mental health and mental wellbeing outcomes were considered, ranging from momentary 6 mood to suicide risk. Other health outcomes included life satisfaction, wellbeing, (recalled) 7 restoration, problem behaviour, and mental health problems.

8 A total of twenty-four papers reporting twenty-six studies were included in the review after filtering 9 against the inclusion/exclusion criteria (six experimental papers with eight studies, twelve cross- 10 sectional, and six qualitative papers). The oldest paper was published in 2013. A critical appraisal was 11 performed to assess the risk of bias, after which three further studies were excluded due to low 12 quality (one for each category).

13 The narrative synthesis revealed that the majority of studies (18) looked at the salutogenic effects of 14 the coast. In addition, most studies looked at a specific type, rather than characteristics, of blue 15 space. Fourteen of the twenty-six studies were conducted in the United Kingdom. Participants 16 numbers ranged from eleven to an entire population, and included the elderly, children, 17 representative panel data, convenience samples, and people with mental distress. Most studies 18 investigated the effects of blue space on affective outcomes, but wellbeing, life satisfaction, 19 (recalled) restoration, general mental health problems, and problematic behaviour were also 20 examined.

21 Benefits of the coast were found across all three study categories. Studies looking at direct effects of 22 coastal exposure, as opposed to just coastal availability or proximity, showed more consistent 23 positive results. Few studies investigated inland water exposure, looking at either a river, a canal, a 24 wetland, or at the percentage of freshwater around the residence. It appeared that positive 25 associations with mental health were less clear for inland waters than coastal blue space. Across blue 26 space categories, the most pronounced effects were found for affect and affective disorders. 27 Qualitative studies pointed towards unique and beneficial characteristics of blue spaces, including 28 the visual openness of the space and fluidity of the water.

29 Too few studies in each category were present to allow for firm conclusion and recommendations. 30 The outcomes of the systematic review signal the need to look beyond mere availability and 31 proximity of blue spaces, to actual exposure and the experiences people have in blue space. 32 Moreover, this review was aimed at urban and peri-urban exposure to blue space. The majority of 33 studies reported effects of the coast and this type of blue space is geographically limited and will 34 certainly not pertain to most urban and peri-urban areas. The main conclusion of the systematic 35 review is that in this relatively young field of research more high quality research is necessary, 36 including a focus on a wider range of blue space (particularly inland water) types, blue space 37 characteristics, and geographical locations (especially beyond the United Kingdom). The outcomes do 38 point at beneficial effects of blue space visits and visibility, at least for the coast. Qualitative studies 39 have provided insights into the experiential characteristics of blue spaces, which would certainly

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1 guide future research, such as the unique dynamic and fluid characteristic of water and the sense of 2 visually open space.

3 2. Background

4 In an increasingly urbanizing world, pressures are growing on natural ecosystems. Furthermore, 5 urbanization is associated with an increase of several mental disorders (Srivastava, 2009) .To reduce 6 negative mental health effects in cities, functional and healthy ecosystems are a necessity (WHO, 7 2016). Policy makers, designers, planners and practitioners face the challenge of creating natural 8 resources and preserving and conserving existing ones that are important for maintaining and 9 optimizing human wellbeing. In an urban context, space is a scarce resource. Therefore, knowing 10 which type of blue and green spaces, with which characteristics, are most beneficial for wellbeing is 11 critical. It is exactly this question that lies at the core of the request put to EKLIPSE’s experts.

12 Aims and objectives 13 In March 2017, EKLIPSE called for experts (call for experts No. 2/2017) to assess and share existing 14 knowledge across disciplines, following up a request initially formulated by the Expert Working 15 Group Biodiversity & Health, 3rd National Plan on Health and Environment (PNSE3) – Ministry 16 in charge of the Environment (MTES), France. MTES aims to provide recommendations for the 17 “conservation, creation, design and management of natural spaces that would benefit urban citizens, 18 by maintaining or enhancing their mental health and wellbeing”, as well as promoting systematic, 19 interdisciplinary, and cross-cultural research.

20 The request 21 The request was as follows:

22 “Which types of urban and peri-urban green and blue spaces, and which characteristics of such 23 spaces, have a significant impact on human mental health and wellbeing?”

24 The intention of the request is to provide guidelines and recommendations to policy makers, 25 practitioners and researchers regarding the planning, design, construction, and management of 26 green and blue spaces in urban or peri-urban areas to promote the mental health and wellbeing of 27 urbanites.

28 After a preliminary scoping exercise, it was agreed with the requester to specifically focus on 29 comparing different types of urban and peri-urban green and blue spaces and/or variations in 30 green/blue space characteristics. It was decided to perform two systematic reviews, one for blue and 31 one for green space. This report presents the outcomes for the blue space systematic review.

32 The expert working group 33 The expert working group was composed of 11 members from 7 countries. A range of disciplines and 34 backgrounds were covered: urban ecology, biology, landscape architecture, medicine, psychology, 35 and sociology. Communication was maintained across the team via email and virtual meetings, with a 36 series of face-to-face meetings organised by EKLIPSE to facilitate key stages of the work. Experts 37 worked intuitu personae, and on a voluntarily basis without receiving financial compensation. A post-

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1 doc fellow joined the expert working group in April 2019 to help conduct the work, with the financial 2 support of EKLIPSE. Librarians were employed as part of the expert working group, conducting the 3 systematic literature searches and to assisting with the first stages of eligibility screening. This was 4 made possible with the financial support of the WHO.

5 Theoretical framework: Blue space and mental health and wellbeing 6 “Most of the earth's surface is covered by water, and most of the human body is composed of water 7 – two facts illustrating the critical linkages between water, health and ecosystems.”

8 (WHO, 2017)

9 The above often-cited quote from the World Health Organization illustrates the importance of water, 10 and thus blue space, for human existence and health. Recent research further stresses that blue 11 space is not only linked with physiology and physical health, but that it also provides numerous 12 opportunities for restoration, and serves to maintain and improve mental health (e.g., lower 13 depression rates).

14 A number of reviews have already focused on the salutogenic effects of proximity to and availability 15 of blue space on physical and mental health (Gascon et al., 2017; Volker & Kistemann, 2011), or the 16 efficacy of therapeutic activities performed in blue space for mental health (Britton, et al., 2018). 17 These reviews generally point to a beneficial relation between the amount of blue space and mental 18 health and wellbeing. Such associations have, for instance, been found for self-reported mental 19 health (Alcock et al., 2015) or physiological outcomes (e.g., heart rate, blood pressure; Hignett et al., 20 2018) following exposure to blue space.

21 Four pathways have been identified for the beneficial effects of nature (either green or blue) on 22 health (Hartig, Mitchell, De Vries, & Frumkin, 2014): 1) stress reduction, 2) physical activity, 3) social 23 cohesion, and 4) air quality. Three of these pathways (all but air quality) have been discussed within 24 the blue space literature (Gascon et al., 2017; Lovell, Husk, Cooper, Stahl-Timmins, & Garside, 2015; 25 Nutsford, et al., 2016; White, et al., 2013), see Figure 1.

26 The first pathway has traditionally received most empirical and theoretical attention. Restoration 27 theories have proposed evolutionary-based positive affective responses to nature (Stress Reduction 28 Theory; Ulrich et al., 1991), as well as cognitive recovery and resource replenishment after viewing 29 natural settings (Attention Restoration Theory; Kaplan, 1995). These two theories mainly rely on 30 aesthetic and visual qualities of the natural environments, and are related to presumed intrinsic 31 characteristics of nature. Humans are proposed to have an intrinsic affection toward unthreatening 32 nature, a term that has been labelled ‘biophilia’, as opposed to ‘biophobia’ relating to for instance 33 innate fight or flight responses we have toward snakes and spiders (Kellert & Wilson, 1995; Ulrich, 34 1993). Stress-reduction may also come about through the absence of noise and crowding in more 35 natural environments (Hartig et al., 2014). Indeed, research has indicated from a wide range of 36 environmental types, people mostly preferred blue space for relaxing and recovering from daily 37 stressors, more than for instance urban parks (White, Pahl, Ashbullby, Herbert, & Depledge, 2013).

38 The second pathway, physical activity is currently increasingly gaining attention. Blue spaces offer 39 opportunities for many different forms of physical activity (e.g., swimming, sailing, walking). Physical 40 activity, in turn, has been demonstrated to have beneficial effects on mental health (Bize, Johnson, & 41 Plotnikoff, 2007). Furthermore, blue space often offers opportunities for leisure and recreation at

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1 relatively low costs (Haeffner, Jackson-Smith, Buchert, Risley, & planning, 2017; White, Pahl, 2 Wheeler, Fleming, & Depledge, 2016).

3 Improvements in social interactions (at the individual level) and social cohesion (at the 4 neighbourhood level) is a third proposed pathway linking nature exposure with mental health. The 5 link between social interaction and mental health has been firmly established (Holt-Lunstad, Smith, & 6 Layton, 2010) and some studies have also pointed towards the beneficial effects of blue space on 7 social interaction (De Bell, Graham, Jarvis, White, & Planning, 2017), although this has received less 8 research attention.

10 Blue Space 11

13 Social Physical Restoration 14 interaction activity 15

17 Mental health 18

20 Figure 1. Proposed pathways for the mental health benefits of blue space 21 Even though the beneficial effects of blue space exposure have been observed, systematic reviews 22 on the benefits of the amount of blue space exposure on health have all identified a need for more 23 research on this relatively new topic (Britton et al., 2018; Gascon et al., 2017). In addition, the 24 geographical diversity of urban settings and the heterogeneity of objectives, theoretical frameworks, 25 and research methods in the reviewed studies made the comparison and establishment of robust 26 results difficult (Britton et al., 2018; Frumkin et al., 2017; Gascon et al., 2017; Hartig et al., 2014).

27 In existing blue space research, similar to green space research, the focus is often on the amount or 28 proximity of blue rather than the typology or specific qualities of blue environments. According to 29 the international research agenda proposed by Frumkin and colleagues (2017) on the health-benefits 30 of nature contact, the research outcomes have not progressed significantly. They conclude that 31 “standard exposure measures are not grounded in the ecological elements most relevant to human 32 health and wellbeing” (p. 6). For example, the quantity of nature is often measured using aerial 33 photography or remote sensing techniques. Such data offer little information on the quality of the 34 landscape view from the ground level, do account for how often residents interact with these 35 natural environments, or focus on other attributes which may be important in terms of generating 36 positive health outcomes. More knowledge on the importance of the type, characteristics of blue

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1 space, may help to unlock its potential to contribute to human health (Frumkin et al., 2017; van den 2 Bosch & Sang, 2017; Zürcher & Andreucci, 2017) and can thus inform planning and management 3 decisions.

4 The framework by Frumkin and colleagues explicitly includes identifying a measurable element of 5 nature and identifying a key characteristic of this natural element. Similarly, a recent conceptual 6 model aimed at translating outcomes of research on the restorative effects of nature on mental 7 health benefits and implementing nature as an ecosystem service (Bratman et al., 2019) also 8 included natural features as a key component. Specifically, they refer to differences in biodiversity 9 and differences in vegetation. Besides natural features, the model also points to the importance of 10 exposure – operationalized as accessibility, proximity, and actual time spent in nature, which are all 11 related to the design and composition of natural landscapes. The third component ‘experience’ adds 12 to ‘exposure’ by looking at the (sensory) qualities of natural areas, the way people interact with it, 13 and the dose (or the “absorbed internal dose”). In other words, a distinction is made between 14 “objective” exposure and how much effect this exposure has by individual differences in, for 15 instance, connectivity with nature or attention. The last component refers to the range of mental 16 health effects that can be expected.

17 There is thus both a practical and theoretical need to gain a better understanding of which types and 18 characteristics (or features or elements) of blue space matter most for urban residents in terms of 19 mental health and wellbeing. The objective of the present systematic review was tackle this 20 knowledge gap. This review aims to inform and provide recommendations to decision makers in 21 several domains, such as health promotion, nature management, spatial policy, and urban planning 22 and design.

23 3. Method

24 The systematic review adhered to the Preferred Reporting Items for Systematic reviews and Meta- 25 Analyses (PRISMA) guidelines (Moher et al., 2010) and consisted of six consecutive steps; literature 26 search, eligibility screening, meta-data extraction, critical appraisal, descriptive synthesis, and 27 narrative synthesis. A protocol of the systematic review is available on the website of EKLIPSE 28 (http://www.eklipse-mechanism.eu/health_activities).

29 3.1 Literature search

30 Search strategy 31 The search strategy to retrieve evidence for the impact of blue spaces on mental health conditions 32 was developed in MEDLINE, and run in the databases MEDLINE, Web of Science, and Scopus. After 33 completion of the MEDLINE and Web of Science searches, it became clear that some known relevant 34 records were not being identified by the searches. The majority of these records were from the 35 Journal of Landscape and Urban Planning. A focused search of this journal was therefore undertaken 36 in Scopus.

37 The searches examined journal article subject headings, as well as the title, abstract and keywords. 38 Search terms for blue spaces were combined with terms for mental health and wellbeing.

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1 The search was multi-stranded and had two searches which were combined with the Boolean 2 operator OR. The second strand was developed after the first search was tested against a set of 3 reference papers (see appendix A) and was found to miss some known relevant studies. The search 4 was constructed as follows:

5 1. Strand 1: blue spaces AND general or specific mental health issues (lines 1 to 60, see Appendix 6 A)

7 2. Strand 2: blue space terms in title/abstract/author keywords AND psychological terms in the 8 title only (lines 61 to 75)

9 3. Strand 1 OR strand 2 (line 76)

10 The searches were limited to English language only. In both MEDLINE and Web of Science, animal 11 studies were removed using a standard algorithm. Publication types found via MEDLINE which were 12 unlikely to yield relevant information, such as comment pieces, editorials, news, letters and case 13 reports, were also excluded. In Web of Science, the following article categories were excluded as 14 these were deemed unlikely to yield relevant information: geosciences, multidisciplinary, chemistry 15 physical, geography physical, fisheries. The titles and abstracts of bibliographic records were 16 downloaded and imported into the bibliographic management software EndNote, before all 17 duplicate records were deleted.

18 Eligibility 19 The search was restricted to papers from peer-reviewed journals. Eligibility was defined based on the 20 PICO/PECO approach; PICO stands for Population (or Patient or Problem), Intervention, Comparison, 21 and Outcome, and defining the PICO terms is an integral part of a Cochrane Review (Higgins & Green, 22 2011). In PECO, the E stands for Exposure and allows for the inclusion of cross-sectional studies 23 (without an intervention), which, even though they do not allow for causal inferences, can be highly 24 informative in this field of research.

25 Population 26 No restrictions were made in terms of the population. However, single-case or single-case studies 27 (n=1) were excluded.

28 Intervention 29 Eligible blue space interventions were those that manipulated or changed the exposure to blue 30 space, either by targeting its characteristics or habitat type. The amenities and facilities present in a 31 blue space were also of interest, as these may influence accessibility, affordances, and attractiveness, 32 and, thereby, the exposure and type of contact. Studies investigating only the efficacy of therapeutic 33 interventions in blue environments were excluded from the systematic review. This is because the 34 intervention is focused on human beings, unless these studies also included an intervention on the 35 physical environment, such as the design of a therapy garden incorporating blue space.

36 Exposure 37 Only studies investigating exposure to outdoor blue space were deemed eligible (e.g., studies 38 investigating effects of an aquarium were excluded). Exposure to nature can be divided into indirect,

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1 incidental, and intentional interactions with nature (Keniger, Gaston, Irvine, Fuller, & health, 2013). 2 All types of exposure were included in the review, both intentional and incidental. For indirect 3 interactions, viewing representations of nature, as well as viewing nature through a window were 4 included. However, we distinguished between real and direct exposure to blue spaces. Studies 5 looking at rural exposure to blue space were also included in the review, as they could still inform 6 about mental health benefits of these types of blue space and characteristics.

7 Comparison 8 Only studies investigating exposure to outdoor blue space were deemed eligible (e.g., studies 9 investigating effects of an aquarium were excluded). Exposure to nature can be divided into indirect, 10 incidental, and intentional interactions with nature (Keniger, Gaston, Irvine, Fuller, & health, 2013). 11 All types of exposure were included in the review, both intentional and incidental. For indirect 12 interactions, viewing representations of nature, as well as viewing nature through a window were 13 included. However, we distinguished between real and direct exposure to blue spaces. Studies 14 looking at rural exposure to blue space were also included in the review, as they could still inform 15 about mental health benefits of these types of blue space and characteristics.

16 Outcome 17 A wide range of mental health and wellbeing outcomes were included in the review, ranging from 18 momentary mood to suicide rates. Included categories encompassed: general mental health (i.e., 19 quality of life, satisfaction with life, subjective wellbeing); acute and direct effects on momentary 20 mood, stress, and mental fatigue; retrospective reporting of momentary mood (i.e., recalled 21 restoration); prevalence and severity of mental health problems; and specific correlates of mental 22 health (e.g., loneliness, sleep, and pain). The World Health Organization ICD-10 mental health 23 classification system (WHO, 1992) was adhered to: affective disorders, stress-related diseases; 24 schizophrenia, psychosis, paranoia; personality disorders; disorders of psychological development; 25 cognitive dysfunction; neurodegenerative disease; problem behaviour. Studies looking only at 26 preference ratings, perceived restorativeness, expected restorative effects physical health correlates 27 of mental health (such as physical activity without looking directly at mental health outcomes) were 28 excluded. Studies looking at psychological states directly linked with mental health (such as 29 loneliness) were included in the review.

30 Qualitative studies were searched for using the same inclusion and exclusion criteria. These studies 31 were included to identify in-depth insights into people experiences of engaging with blue spaces and 32 the meanings people ascribed to these experiences. .

33 Record selection 34 Obviously ineligible records in EndNote by a single reviewer, with a sub-set screened by a second 35 reviewer to verify accuracy. Potentially eligible records were then loaded into a systematic review 36 management system (Covidence), before the titles and abstracts were screened against the eligibility 37 criteria. A conservative approach was taken, whereby any paper that was not obviously ineligible was 38 retained. Subsequently, the expert working group screened the records at full text in Covidence. 39 Each document was screened by two reviewers independently. Where there was disagreement, a 40 third reviewer would look at the full text to resolve the conflict.

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1 3.2 Meta-data extraction 2 An extensive compilation of descriptive data was extracted from each individual selected paper. Data 3 were gathered across four different categories: general study information, methodology, blue space, 4 and mental health (Table 1).

5 Table 1. Overview of the information extracted during the meta-data phase General Methodology Blue space Mental health First author Type of data (quantitative, Operational definition of Typology of outcome qualitative) blue spaces measure Year of publication Study design Diversity of habitats (i.e., Measurement (cross-sectional, does the study look at one instruments used experimental, or qualitative) or multiple types of blue (not applicable for space) qualitative studies) Paper title Data collection method Type of blue space Results (e.g., survey or interview) exposure (indirect versus direct) Journal name Participant recruitment Type of blue space Covariates and process confounding variables (not applicable for qualitative studies) Country the study Population type Description of the blue took place in space characteristics Location the study Inclusion and exclusion Blue space size (km2) took place in criteria for participation Season the study Sample size (number of Duration and frequency of took place in participants) visits Sample age (mean and Activities performed in the standard deviation) blue space Sample age (range) Type of environmental assessment (e.g., residential exposure, blue space visits) Sample percentage female Study duration Rationale behind method (qualitative studies only) 6

7 3.3 Critical Appraisal 8 During the critical appraisal phase, the risk of bias being incorporated into the study was assessed for 9 each of the three types of study separately. The criteria were developed specifically for this 10 systematic review, but based on existing critical appraisal tools, namely the Cochrane Collaboration 11 Tool (Higgins & Green, 2011) and the Quality in Prognostic Studies tool (Hayden, van der Windt, 12 Cartwright, Côté, & Bombardier, 2013). One custom item was added for the quantitative categories, 13 assessing risk of bias of the blue space manipulation.

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1 A three-level scoring (‘high’, ‘moderate’ and ‘low’ confidence of no bias) was used, with a fourth ‘not 2 applicable’ category. For each scoring option, the criteria were defined at the onset of the critical 3 appraisal process. Each paper was assessed independently by two or three members of the expert 4 working group.

5 Experimental 6 Risk of bias in the experimental studies was assessed on the basis of seven different categories (Table 7 2): selection bias, performance bias, attrition bias, detection bias, manipulation, reporting bias, and 8 covariates. These categories investigated potential bias during every stage of the study procedure, 9 starting at the selection of the participants and how they related to the true population. Next, 10 performance bias was targeted in the allocation of participants to experimental conditions and the 11 blinding of participants for the manipulations. Attrition was included as dropouts during the 12 experiment, which may cause bias in the outcomes. Detection bias investigated whether there was 13 direct contact between the researcher and the participants. Unique to the type of studies assessed in 14 this systematic review are the environmental manipulations related to the blue space type or 15 characteristics. A separate category therefore assessed whether any potential bias could have been 16 introduced to the studies by the choice and execution of blue space manipulations. Specifically, the 17 duration and frequency of blue space exposure were taken as a measure of potential bias as longer 18 and more frequent exposure may provide better or more consistent results. The two last categories 19 tested for bias in the analysis phase of the study; specifically looking at whether authors reported all 20 outcomes (including non-significant outcomes) and had identified and accounted for covariates in 21 the analysis. See Table 2 for an overview of the items and the criteria.

22 Cross-sectional 23 Six categories (selection bias, attrition bias, detection bias, manipulation, reporting bias, covariates) 24 were employed to assess the risk of bias for the cross-sectional studies (Table 3). These categories 25 were very similar to those used for the experimental studies, except that no assessment was made of 26 the performance bias as it is irrelevant for cross-sectional studies as there are no experimental 27 manipulations.

28 Qualitative 29 The bias assessment of the qualitative studies differed from the two quantitative categories, due to 30 the difference in study characteristics and objectives. Five items were considered in two categories 31 (selection bias and qualitative methods) (Table 4). The assessment focused on clarity in the 32 description of the sampling used and recruitment of participants. In addition, the qualitative method 33 was assessed on whether independent raters were used in the analysis, whether stakeholders were 34 involved during the analysis, and if triangulation of methods was implemented. 35

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1 Table 2. Critical appraisal items for the experimental studies 2 Catego Criteria for confidence of no bias ry Item High Moderate Low Not applicable Representative Random sampling is used Purposive sampling is used; Convenience sampling is - sampling (probability sampling); the researchers have sampled employed; sample is drawn for sample is representative for the individuals for a specific the part of the population that population under study purpose, but non-probability is close to hand, non-probability sampling was used. sampling Sample description The authors provide a Authors describe the sample No description was provided in relation to description of both the true but provide no description of population population and the sample the true population Baseline study At baseline, the groups are At baseline, the groups are not It is unknown whether the It is only one group (i.e., it is a characteristics similar on the value of the similar on the value of the groups in different conditions within subjects design, not a dependent variable, unless dependent variables unless are similar in terms of their between-subjects design) differences were included differences are purposefully, score on demographic or purposefully but they are similar in independent variables composition in demographic variables

Random allocation Participants were randomly Participants were only semi- No description was provided or It is only one group (i.e., it is a of participants to assigned, allocation was based randomly assigned, allocation participants were not randomly within subjects design, not a the experimental on chance. was according some pre-set assigned between-subjects design) conditions plan (e.g., a list on paper) Selection bias Order of The order in which participants One or more orders is missing, No description was provided; or - conditions, are exposed to a condition, or order is not fully randomized order of conditions, interventions, or intervention or stimuli is/are (e.g. 123, 321) interventions or stimuli to stimuli to randomized participant was not randomized participants Performance bias 3

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2 Cate- Confidence of no bias – criteria Gory Item High Moderate Low Not applicable Blinding of Authors report their efforts for Authors acknowledge that No description was provided -

participants blinding the participants for the blinding was not done / not research purpose possible and recognize this may have influenced the outcomes Performance bias (cont.) Attrition There is evidence of no attrition drop-out rates are described no description of attrition (drop-outs) there is only one (note: attrition only applies to the (first and final sample size) but was provided measurement, no period after the study has started), no analyses have been attrition (drop-out) i.e., there are no drop-outs. OR: conducted into the possible

there is attrition but it is reported consequence of attrition and the consequence on the outcomes are taken into account in the analyses. Attrition bias

Blinding of There is no direct contact between - There is direct contact between the - outcome the researcher and the participant, researcher and the participants,

assessment including questionnaires delivered including questionnaires delivered by remotely hand Detection bias

Is the Direct exposure is described in - there is no description about the - manipulation terms of duration and frequency characteristics of the exposure, or clearly only availability (indirect exposure) is defined assessed Manipulation 3

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Category Confidence of no bias – criteria Item High Moderate Low Not applicable Treatment The treatments in both groups The treatment of each group No description was provided Not applicable when there is similarity were exactly the same (except in was similar on some aspects, only one group blue space type or characteristics) but differed on others

in duration, timing, intensity of (aspects as described in the physical activity, location (both 'high score' field) indoors or both outdoors) and these similarities are described Manipulation Manipulation (continued) Selective authors report or mention non- Authors do not mention or Non-significant results were -

reporting significant results (e.g table of all report non-significant results. not reported. evidence of results is reported in the paper; or partial reporting (some statement that results were non- results are missing), and no significant) explanation why Reporting bias Covariates Covariate (s) are identified and Covariate(s) have been Covariate(s) were not Not applicable, for true

taken into account in the analyses identified, but they are only identified experiments with good being discussed (not included random allocation to in the analyses) conditions with no difference on baseline Covariates

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1 Table 3. Critical appraisal items for the cross-sectional studies 2

Cate- Confidence of no bias – criteria gory Item High Moderate Low Not applicable Random Participants were selected based Participants were selected by No description was provided a census was used (census selection on a priori plan to ensure chance, or participants were means: every possible record participants randomization self-selected was available to the researcher) Sample The authors provide a description The authors provide a No complete description was a census was used (census

description in of both the true population and description of both the true provided means: every possible record relation to the sample, and there is evidence population and the sample, was available to the population that the sample is representative but there is evidence that the researcher) (at the start in case there are sample is not representative multiple measurements) Selection bias Proportion of There is evidence of no attrition drop-out rates are described no description of attrition there is only one baseline (note: attrition starts only applies (first and final sample size) but (drop-outs) was provided measurement, no attrition sample to the period after the study has no analyses have been (drop-out) possible available for started), i.e., there are no drop- conducted into the

analysis outs. OR: there is attrition but it is consequence of attrition reported and the consequence on the outcomes are taken into account in the analyses. Attrition bias

Blinding There is no direct contact between There is direct contact the researcher and the between the researcher and participant, including the participants, including questionnaires delivered remotely questionnaires delivered hand to hand Detection bias 3

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Cate- Confidence of no bias – criteria Gory Item High Moderate Low Not applicable

Is the manipulation Direct exposure is described in Direct exposure is described in There is no description about clearly defined terms of duration and terms of duration the characteristics of the frequency exposure, or only availability (indirect exposure) is assessed Manipulation Selective reporting Authors report or mention Authors do not mention or Non-significant results were

non-significant results (e.g report non-significant results. not reported. evidence of table of all results is reported partial reporting (some results in the paper; or statement are missing), and no that results were explanation why nonsignificant) Reporting bias Covariates Covariate(s) are identified and Covariate(s) have been Covariate(s) were not

taken into account in the identified, but they are only identified analyses being discussed (not included in the analyses) Covariates

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1 Table 4. Critical appraisal items for the qualitative studies 2

Cate- Confidence of no bias – criteria 3 gory Item High Moderate Low 4 Source of target population - There is a description of the There is no description of the sample sample 5

Recruitment description Purposeful / systematic Convenience sampling; The There is no description of the6 sampling; the authors of the researchers have taken people sampling process papers have chosen the as they volunteered and were people who were sampled available 7 Selection bias Independent raters There are two or more There was only one person No description was provided 8 independent raters that code coding the data the data 9 Stakeholder involvement Stakeholders (non-academic) Stakeholders (non-academic) No stakeholders (non- are involved in the entire are involved in only part of the academic) are involved or no research process (from the research process (only design description was given 10

design of the method to the of method or only at the analysis of the outcomes) outcomes) 11 Triangulation A mix in research methods or A mix in research methods or No mix in research methods, data sources were employed data sources were employed, data sources, or researchers12 and the outcomes were used but they were not used (backgrounds) was employed together in the analysis together in the analysis 13 Qualitative method Qualitative 14

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1 3.4 Synthesis 2 After completion of the critical appraisal, a narrative synthesis was performed. Studies scoring low 3 quality (i.e., a ‘low’ score in the critical appraisal) for more than half of the critical appraisal 4 categories were excluded from the synthesis. Thus, studies with more than and more than six, four , 5 or three ‘low’ scores in respectively the experimental, cross-sectional, and qualitative category. The 6 narrative synthesis consisted of four consecutive steps: developing a theory of change, performing a 7 preliminary synthesis, exploring relationships within and between studies, and assessing the 8 robustness of the synthesis (Popay et al., 2006).

9 The theory of change, or the conceptual framework, summarized the expected underlying 10 mechanisms of the benefits of blue space on mental health. Its purpose was to guide the selection of 11 studies, the categorization of studies, as well as performing the synthesis. The theory of change has 12 already been described in the theoretical background of this report (section 1.2).

13 During the preliminary synthesis, study outcomes were grouped and tabulated per study type 14 (experimental, cross-sectional, qualitative) and blue space type, divided into two broad categories: 15 sea/coast or inland waters. Groupings and tabulations were also made per outcome measure, 16 divided into the categories: affective; wellbeing; restoration; mental health problems; life 17 satisfaction and quality of life; and behavioural problems. Also, a distinction was made between 18 studies with direct exposure versus those with indirect representations of blue space (e.g., videos 19 and Virtual Reality).

20 After these overviews were created, results were further analysed by looking at differences in 21 possible moderators, such as type of activity, the study design, the sample, and risk of bias 22 (outcomes from the critical appraisal), to understand the observed heterogeneity in outcomes. 23 Conceptual maps were created to reveal patterns in the outcomes and to further explain 24 heterogeneity. Lastly, triangulation was also assessed, both in terms of methodology used and 25 background of the researchers.

26 The fourth, and final, step in the synthesis was to investigate the strengths and weaknesses of the 27 systematic review process and, subsequently, the robustness of the outcomes. This was done not 28 only by critically reflecting upon the synthesis phase, but also by looking at the generalisability of the 29 synthesis product to the general population. The outcomes of this assessment are reported in the 30 Discussion.

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1 4. Outcomes

2 4.1 Search outcomes 3 The searches of MEDLINE and Web of Science were undertaken on 29 November 2018, and 4 identified 26,873 records (Table 5). Following deduplication, 22,707 records were assessed for 5 relevance. The Scopus search was undertaken on 7 February 2019 and retrieved a further 47 6 records.

7 Table 5. Literature search results

Resource Number of records identified

Web of Science (SCI-EXPANDED, SSCI, A&HCI) 20,099

MEDLINE 6,774

Scopus 47

Total number of records retrieved 26,920

Total number of records after deduplication 22,755

9 After deduplication, 22,201 records were rejected based on an assessment of the title and abstract. 10 A total of 554 records were loaded into Covidence, with 145 then assessed at full text after title and 11 abstract filtering. After assessment of the full texts, 24 papers were selected as eligible (Figure 2): 7 12 experimental papers (8 studies); 12 cross-sectional papers; and 6 qualitative papers. Table 6, 7, and 13 8 provide a summary of the included studies.

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1 2 Records identified through database 3 searching 4 (n = 26,920) 5 6 7 8 9 10 Records after duplicates removed 11 (n = 22,755) 12 13 14

15 Records screened Records excluded at title 16 (n = 22,201) (title) 17 (n =22,755) 18

20 Records screened (title and Records excluded at title and abstract) abstract (n = 554) (n =409) 21

24 Full-text documents assessed Records excluded at full text for eligibility (n = 121) 25 (n = 145)

Records included in the 28 review (n = 24)

31 Figure 2. The PRISMA Flowchart for the study selection

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1 Table 6. Overview of the included studies; experimental Article Blue space Blue space description Participants Indirect or Type of outcome Results category direct Triguero-Mas, et Coast River dominated delta 26 participants Direct Mood, Better mood and HRV compared to a;., 2017 beach with indications of physiological urban environment psychological stress, restorative distress outcomes Tsutsumi, et al., Coast Visuals and sounds of the 12 healthy men in Indirect Mood, Groups were divided based on 2017 sea their twenties physiological preference for either a sea or a forest stress movie. For those who preferred the sea movie, mood improved after watching sea movie, parasympathetic nerve activity increased while watching the sea video and heart rate decreased. Similar effects were found for watching a forest movie (for those that preferred the forest movie). Emfield & Neider, Coast Images and sounds of 202 graduate Indirect Mood, relaxation No effect on mood, but participants 2014 natural beaches and the students reported finding the images (and ocean sounds) more relaxing than the urban counterparts Tanja-Dijkstra et Coast Virtual reality coastal 85 students & 70 Indirect Experienced pain, Less experienced pain, no effect on al., 2018 environment dental patients vividness of vividness of memory compared to no VR memory (Study 1) or an urban VR (Study 2). White, et al., Coast Different types of beach 1478 panel Indirect Mood and Perceived biodiversity and fascination 2017b images with three levels of members recovery level was positively related with mood biodiversity/videos of and recovery coastal wildlife differing in fascination level Rogerson et al., Coast Beach route on and below 331 participants Direct Stress, mood No difference between running 2016 /inland the clifftops; riverside from a environments, as self-esteem and mood route within an urban park; convenience improved and self-reported stress heritage route overlooking sample decreased along all routes. river

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Article Blue space Blue space description Participants Indirect or Type of outcome Results category direct Gidlow et al., Inland River promenade 38 locals Direct Mood, cortisol, Mood and cortisol improved in all 2016 experienced conditions (blue, urban, green), restoration perceived exertion lower at the river promenade than during the two other conditions. 1

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1 Table 7. Overview of the included studies; cross-sectional Article Blue Blue space Participants Direct or Type of outcome Results space description Indirect category Qiang et al., 2019 Coast Sea view 13 Direct Ratio of depressive disorder, No significant relation between ocean visibility and the communities ratio of mental bad days mental health outcomes Dempsey et al., Coast Coastal 8504 people Direct Depression prevalence Lower risk of depression when living closer to the sea, 2018 proximity and aged over 50 and when sea view increased. Sea view had a stronger sea view from association with depression levels than distance home Helbich et al., 2018 Coast Coastal Almost entire Direct Suicide rate No relation between coastal proximity and suicide rate proximity Dutch population (382 municipalities) Amoly, et al., 2014 Coast Beach 2111 school Direct Problematic behaviour: Annual beach attendance was negatively related with children Strengths and Difficulties several, but not all, SDQ outcomes. No association was Questionnaire total scores found with the ADHD measures and subscale (parents rated), ADHD symptom criteria (teacher rated) White et al., 2013a Coast Coastal Panel data: Direct Mental distress (GHQ), Living closer to the coast was related (in the fully proximity 139632 for global life-satisfaction adjusted model) to mental health, but not to life mental distress, (single item) satisfaction 91765 for life satisfaction White et al., 2017a Coast Coastal Panel data: Direct Evaluative wellbeing, In fully adjusted model, no relation between coastal proximity 32482 urban eudaimonic wellbeing, proximity and evaluative wellbeing, eudaimonic peri-urban experiential wellbeing: wellbeing, experiential happiness yesterday, and dwellers happy – anxious experiential anxiety yesterday Mackerron & Coast Coast & marine 20000 app users Direct Momentary happiness Marine and coastal margins are associated with higher Mourato, 2013 and + wetlands, momentary happiness than wetlands, freshwater and inland freshwater, flood plains flood plains 2

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Article Blue Blue space Participants Direct or Type of outcome Results space description indirect category White et al., 2013b Coast Coast, beach, Panel members: Direct Recalled restoration No significant effect of river/lake/canal, a significant and river/lake/canal 4255 benefit for coast and beach compared to the open inland countryside Alcock et al., 2015 Coast Saltwater, 2020 rural Direct Mental health (general Significant positive relation between coastal proximity and freshwater, residents health questionnaire) and mental health, no relation with freshwater, negative inland coast relation with salt water and mental health. Only for within variation --> people that moved. No effects were found for people that did not relocate Pedersen et al., Inland Three different 473 residents Direct Perceived Quality of Life, Helsingborg scored higher on several items of quality of 2019 Wetland areas Perceived restorative life and on affect than the other two wetlands. Qualities, Affective Helsingborg is the only wetland integrated in the responses residential area. Bryce, 2016 Other Marine 1220 divers and Direct Experienced wellbeing in Factor analysis revealed three outcome factors; anglers three factors: engagement engagement and interaction with nature; place identity; with nature, place identity, therapeutic value. No significant differential influence of therapeutic value the different marine characteristics on well-being scores were found. Bitterman, 2017 Other Water and 35 Indirect Relaxing or annoyingness of No difference between water sounds and fountain fountain sound sounds. Better than wind chimes and crickets sounds 1

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1 Table 8. Overview of the included studies; qualitative Article Blue Blue space Participants Direct or Type of outcome Results space description indirect category Bell et al., 2015 Coast Natural variety 33 inhabitants Direct Perceived mental wellbeing Eudaimonic wellbeing, renewal and restoration, of Cornwall restorative immersive experiences after visiting the sea coastal therapeutic experiences path/trail beaches harbour Willis, 2015 Coast Coast/stormy 40 visitors and Direct Feelings of rejuvenation, The landscape at each case study site appears to sea locals at peace, relaxation, being fascinate and captivate visitors and induces emotional Jurrasic Coast, uplifted emotionally responses to it. Responses to this environment included United feelings of being energised and at the same time, Kingdom relaxed, calm and peaceful. Coleman et al., Coast Sandy beaches 11 senior Direct Perceived therapeutic Sea represents a symbolic connection with the past, a 2015 with some large residents benefit - giving structure to fluid context for wellbeing. areas of native everyday life, assist process bush and hilly of grieving (and sky) aiding appreciation of life Ashbullby et al., Coast Beach; Rock 15 families, 24 Direct Psychological wellbeing (e.g. Main reported benefits were psychological (fun, stress 2013 pool parents, 20 feelings of happiness, relief, engagement with nature), and social interaction. children enjoyment, stress relief, Barriers for beach visit were also mentioned. Important sleep, social and family role for parents in beach visits interaction - children and parents) Pitt, 2018 Inland Canal/river: 84 locals Direct Mental health benefits - As urban waterways highlight, not all water is blue. This brown, grey, places to relax and de- is significant because it is qualities associated with green water stress, emotionally blueness (freshness, fluidity, luminescence, rippling) refreshed, peaceful which seem particularly salutogenic. The research reiterates the need for a relational perspective on therapeutic blue spaces, recognising that wellbeing may or may not be enhanced depending on how person and place interact in particular

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Article Blue Blue space Participants Direct or Type of outcome Results space description indirect category Volker & Inland River 113 passers-by Direct Getting away from everyday More pronounced benefits expressed in blue space than Kistemann, 2015 promenade stress e.g. atmosphere in green space, in the four dimensions of therapeutic landscape: experienced, symbolic, social, and activity space 1

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1 4.2 Critical Appraisal

2 Experimental 3 Overall, the confidence of no bias of the experimental papers was poor (Figure 3; Table 9). Only two studies 4 had a high score on half of the assessment criteria. A lack of blinding, both in terms of the outcome 5 assessment and of the participants to the researchers, was especially problematic. Furthermore, none of 6 the studies employed representative sampling or described the sample in relation to the population. 7 However, the experimental papers did generally score well on defining the blue space manipulation in 8 terms of duration and frequency, keeping the treatments similar in all other respects than the experimental 9 factor under investigation, and in avoiding selective reporting.

Representative sampling Sample description in relation to population Baseline study characteristics Random allocation of participants to the… Order of conditions, interventions, or stimuli… Blinding of participants Attrition Blinding of outcome assessment Is the manipulation clearly defined Treatment similarity Selective reporting Confounds and covariates

0 1 2 3 4 5 6 7 8

high moderate low not applicable 10

11 Figure 3. Overall score (confidence of no bias) per item on the critical appraisal for the experimental 12 studies 13

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1 Table 9. Confidence of no bias for the individual experimental studies

population

Representative sampling Sample description characteristics study Baseline Random allocation participants conditions of Order Blinding of participants Attrition Blinding of outcome assessment Definition of manipulation Treatment similarity Selective reporting and covariates Confounds Trigure-Mas et al., □ □ n/a n/a + □ - - + n/a + + 2017 Tsutsumi et al., 2017 □ □ n/a n/a - - - - + n/a + - Rogerson et al., - - - - n/a - - - + + + - 2016* Emfield & Neider, - - + + - - □ + + + + n/a 2014 Tanja-Dijkstra et al., - - - + n/a □ + - + + + + 2018, Study 1 Tanja-Dijkstra et al., □ □ □ + n/a - □ - + + + + 2018, Study 2 White et al., 2017b - □ n/a n/a - - □ + + n/a + + Gidlow et al., 2016 □ □ n/a n/a + + □ - + n/a + + 2 * low quality: low scores on more than half of the items; not included in synthesis 3 + = high confidence of no bias, □ = moderate confidence of no bias, - = low confidence of no bias, n/a = not applicable 4

5 Cross-sectional 6 The confidence of no bias of cross-sectional studies appeared better than that of the experimental studies, 7 although there is much room for improvement (Figure 4; Table 10). Four of the twelve studies scored 8 relatively well, with ‘high’ ratings on more than four of the seven criteria. In contrast to the experimental 9 studies, the cross-sectional studies generally scored well on the blinding of participants, but low on the 10 description of the blue space manipulation. In line with the experimental studies, selective reporting did 11 not occur often.

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1 Table 10. Confidence of no bias for the individual cross-sectional studies

reporting Random selection participants Sample description in relation to population sample baseline of Proportion analysis for available defined clearly manipulation the Is Selective and covariates Confounds Blinding of participants Pedersen et al., 2019 □ - n/a - + - + Dempsey et al., 2018 + + n/a - + + + Helbich et al., 2018 n/a n/a n/a - + + + Amoly et al., 2014 □ □ n/a □ + + + White et al., 2013a + + n/a - + + + White et al., 2017a + + n/a - + + + Bitterman, 2017* - - n/a □ - - + Bryce et al., 2016 □ - n/a - + - + Mackerron & Mourato 2013 □ □ □ - + + + White et al., 2013b + □ □ □ + □ - Qiang et al., 2019 n/a n/a n/a - + - + Alcock et al., 2015 + □ + - + + + 2 * low quality: low scores on more than half of the items; not included in synthesis 3 + = high confidence of no bias, □ = moderate confidence of no bias, - = low confidence of no bias, n/a = not applicable 4

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Random selection participants

Sample description in relation to population Proportion of baseline sample available for analysis Is the manipulation clearly defined

Selective reporting

Confounds and covariates

Blinding of participants

0 2 4 6 8 10 12

High Moderate Low not applicable 1

2 Figure 4. Overall score (confidence of no bias) per item on the critical appraisal for the cross-sectional 3 studies 4

5 Qualitative 6 The confidence of no bias scores were generally low for the qualitative studies (Figure 5; Table 11). Only 7 one article had a ‘high’ rating on three of the five criteria, and two studies only had one ‘high’ score. 8 Qualitative studies scored low on stakeholder involvement and high on recruitment description. Very mixed 9 results were found for triangulation and the employment of independent raters.

Triangulation

stakeholder involvement in the research process

Independent raters

Recruitment description

Source of target population 0 1 2 3 4 5 6

high moderate low 10

11 Figure 5. Overall score (confidence of no bias) per item on the critical appraisal for the qualitative studies 12

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1 Table 11. Confidence of no bias for the individual qualitative studies

population target of Source Recruitment description raters Independent the in involvement stakeholder processresearch Triangulation Bell et al., 2015 □ + □ □ + Volker & Kistemann, 2015 □ + □ - - Coleman et al., 2015 □ + + - + Ashbullby et al., 2015 □ + + - - Pitt, 2018 □ + - - □ Willis, 2015* - + - - □ 2 * low quality: low scores on more than half of the items; not included in synthesis 3 + = high confidence of no bias, □ = moderate confidence of no bias, - = low confidence of no bias, n/a = not applicable 4

5 4.3 Synthesis

6 Descriptive synthesis 7 Three studies were excluded from the synthesis due to low quality (one in each category). No mixed 8 method studies were retrieved and included in the systematic review. The research area is relatively new, 9 as illustrated by the fact that the “oldest” papers included in the review date from 2013. The majority of 10 studies were from the United Kingdom (14/26), eight of which were from the same research group. Most 11 studies looked only at one specific blue environment, with the majority (18) investigating benefits of the 12 coast (Figure 6).

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10 9 8 7 6 5 4 3 2 1 0 Experimental Cross-sectional Qualitative

Coast Inland Other (marine) 1

2 Figure 6. Distribution of studies over the blue space categories, per study type 3

4 Experimental 5 A total of six papers (eight studies) were included in the experimental category. One paper reported a 6 randomized controlled trial (Tanja-Dijkstra et al., 2018). Five studies were conducted in the United Kingdom 7 (Gidlow et al., 2016; Tanja-Dijkstra et al., 2018; White et al., 2017b), one in Spain (Triguero-Mas et al., 8 2017), one in Japan (Tsutsumi et al., 2017), and one in the United States of America (Emfield & Neider, 9 2014).

10 Seven of the eight studies focused on effects of the coast, with only Gidlow and colleagues (2016) 11 investigating benefits of inland water on mental health. Five of the eight studies compared one specific 12 type of blue space with green and/or urban environments (Emfield & Neider, 2014; Gidlow et al., 2016; 13 Tanja-Dijkstra et al., 2018; Triguero-Mas et al., 2017; Tsutsumi et al., 2017). One study compared Virtual 14 Reality exposure to the coast with no direct exposure at all (Tanja-Dijkstra et al., 2018), and two studies 15 looked at characteristics of the coast using a movie or images (ranging in the level of biodiversity and 16 fascination; White et al., 2017b).

17 Two studies implemented real exposure to nature (Gidlow et al., 2016; Triguero-Mas et al., 2017), and the 18 other six studies used representations of nature in the form of videos (Tsutsumi et al., 2017; White et al., 19 2017b ), images (Emfield & Neider, 2014, White et al., S1), and Virtual Reality (Tanja-Dijkstra et al., 2018).

20 Participant numbers ranged between 12 and 1478, and included students (Emfield & Neider, 2014; Tanja- 21 Dijkstra et al., 2018), healthy men (Tsutsumi et al., 2017), subjects with signs of psychological distress 22 (Tiguero-Mas et al., 2017), dental patients (Tanja-Dijkstra et al., 2018), panel members (White et al., 23 2017b), and locals (Gidlow et al., 2016).

24 All studies investigated momentary mental health outcomes, with two studies also looking at the vividness 25 of memory one week after the experiment (Tanja-Dijkstra et al., 2018). Six studies looked at effects on 26 mood (Gidlow et al., 2016; Emfield & Neider, 2014; Triguero-Mas et al., 2017; Tsutsumi et al., 2017; White

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1 et al., 2017b). Three of these studies also included physiological measurements (cortisol levels: Gidlow et 2 al., 2016; heart rate variability: Triguero-Mas et al., 2017; heart rate variability and heart rate: Tsutsumi et 3 al., 2017). Two studies investigated effects on perceived pain (Tanja-Dijkstra et al., 2018), and two studies 4 also investigated recovery (White et al., 2017b).

5 Cross-sectional 6 A total of eleven studies were included in the cross-sectional category synthesis. Again, a relatively large 7 proportion (6) of the studies were conducted in the United Kingdom (Alcock et al., 2015; Bryce et al., 2016; 8 MacKerron & Mourato, 2013; White et al., 2013a; White et al., 2013b; White et al., 2017a;), with the other 9 studies conducted in the Netherlands (Helbich et al., 2018), Ireland (Dempsey et al., 2018), Sweden 10 (Pedersen et al., 2019), Spain (Amoly et al., 2014), and Hawaii, USA (Qiang et al., 2019).

11 Four of the eleven studies looked at associations of the coast with mental health (Dempsey et al., 2018; 12 Helbich et al., 2018; White et al., 2017a; Qiang et al., 2019). Four studies looked at both the coast and 13 inland water (Alcock et al., 2015; MacKerron & Mourato, 2013; White et al., 2013a; White et al., 2013b) 14 One study investigated associations between inland water and mental health alone (Pedersen et al., 2019), 15 while another focused on marina areas (Bryce et al., 2016). All studies used direct exposure to blue space as 16 manipulation.

17 Distance and visit frequency to blue space in the cross-sectional category was defined as a self-reported 18 visits (visit frequency) in four studies (Amoly et al., 2014; Bryce et al., 2016; Pedersen et al., 2019; White et 19 al., 2017a), one study investigated the Euclidian distance to the coast (Dempsey et al., 2018), two studies 20 matched the residential postal code with a land-cover system (GIS) to assess land cover near the home 21 address (Alcock et al., 2015; Helbich et al., 2018), two studies used the linear distance to the coast (White 22 et al., 2013a; White et al., 2017a), two studies looked at the visibility of the sea (Dempsey et al., 2018; 23 Qiang et al., 2019), and one study derived blue space visits from GPS locations of mobile phones 24 (MacKerron & Mourato, 2013).

25 Participant numbers ranged from 473 to a census of the population of the Netherlands (millions of people). 26 In six of the eleven studies, examined participants who were part of a (nationwide) database, or some 27 subset of it (e.g., only people aged over 50, Dempsey et al., 2018; only rural residents, Alcock et al., 2015). 28 In one study, residents of a specific residential area were recruited (Pedersen et al., 2019), another study 29 targeted school children (Amoly et al., 2014), and one study was aimed at divers and anglers (Bryce et al., 30 2016).

31 One study investigated depression levels and prevalence (Dempsey et al., 2018), while another targeted 32 suicide risk (Helbich et al., 2018). General mental health was measured in four studies (Alcock et al., 2015; 33 White et al., 2013a; White et al., 2013b; Qiang et al., 2019). Two studies used happiness as health outcome 34 (MacKerron & Mourato, 2013; White et al., 2017a), and one study focused on restoration outcomes (White, 35 2013b). General wellbeing was measured in two studies (Bryce et al., 2016; White et al., 2017a), whereas 36 three looked at either life satisfaction (White 2013a; White 2013b) or quality of life (Pedersen et al., 2019). 37 Problematic behaviour was targeted in one study (Amoly et al., 2014).

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1 Qualitative 2 Five papers in total were included in the synthesis for the qualitative studies. Three of the five were 3 conducted in the United Kingdom (Ashbullby et al., 2013; Bell et al., 2015; Pitt, 2018), one in New-Zealand 4 (Coleman et al., 2015), and one in Germany (Volker & Kistemann, 2015).

5 Three studies focused on people’s experiences of the coast (Ashbullby et al., 2013; Bell et al., 2015; 6 Coleman et al., 2015). All of these talked about the seaside or coast. In other words, not just the blue sea 7 but also adjacent land-based elements, with the beach mentioned by all three papers. These included 8 mention of nature close to the sea (Bell et al., 2015; Coleman et al., 2015), a rockpool (Ashbullby et al., 9 2013), and a harbour (Bell et al., 2015). The sky was also referred to in Coleman and Kearns (2015). Two 10 papers focused on inland water exposure (Pitt, 2018; Volker & Kistemann, 2015).

11 Mental wellbeing and social interaction were mentioned by Bell et al. (2015) and Ashbulby et al. (2013), 12 therapeutic benefits surfaced in two papers (Bell et al., 2015; Coleman et al., 2015) with other mental 13 wellbeing outcomes only appearing singly by individual papers including stress reduction, relaxation, 14 improved sleep, happiness, peace, and place identity. All-but-one studies included local residents, with the 15 Volker and Kistemann (2015) study being the only one addressing visitors of a specific area. Participant 16 numbers ranged from 11 to 113, and targeted local residents (Bell et al., 2015; Pitt, 2018), senior residents 17 (Coleman et al., 2015), visitors (Volker & Kistemann, 2015), and families (Ashbullby et al., 2013).

18 Narrative synthesis 19 The majority of papers investigated a specific type of blue space rather than highlighting different 20 characteristics of those blue spaces. Therefore, the papers were grouped in two categories: inland blue 21 space and coastal blue space.

22 Experimental 23 All seven experimental studies reported at least one positive short-term effect of exposure to blue space on 24 mental health. Four studies also reported non-significant effects on other outcome variables (Emfield & 25 Neider, 2014; Tanja-Dijkstra et al., 2018; Gidlow et al., 2016).

26 Exposure to the coast was often (4 studies; Emfield & Neider, 2014; Gidlow et al., 2016; Tanja-Dijkstra et 27 al., 2018; Triguero-Mas et al., 2017) contrasted with urban environments and most studies used indirect 28 representations of blue space. Only two investigated effects of direct exposure to blue space (Gidlow et al., 29 2016; Triguero-Mas et al., 2017) and, in both cases, the participants were walking in blue spaces (river 30 promenade and along a river dominated delta beach). Beneficial effects of the coast were reported for both 31 exposure types (direct exposure and indirect representations).

32 All experimental studies but two (Tanja-Dijkstra et al., 2018) focused on momentary mood. Three studies 33 reported significant mood improvements (Triguero-Mas et al., 2017; Tsutsumi et al., 2017; White et al., 34 2017b), and two found no significant effects (Emfield er al., 2014; Gidlow et al., 2016). Mood improvements 35 were reported after exposure to movies of the coast (Triguero-Mas et al., 2017; Tsutsumi et al., 2017) and 36 were found to be correlated to both the biodiversity and fascination level of the beach (White et al., 37 2017b). No mood improvements were reported after viewing images of the coast (coupled with sounds of 38 the sea; Emfield & Neider, 2014), or after a river promenade (Gidlow et al., 2016).

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1 Measurements of mood improvement were supplemented with physiological measurements in three 2 studies (Gidlow et al., 2016; Triguero-Mas, Gidlow, Martínez, et al., 2017; Tsutsumi et al., 2017). Two of the 3 three studies reported beneficial effects of blue space exposure on physiology (Triguero-Mas et al., 2017; 4 Tsutsumi et al., 2017). One of these, however, was a pilot study (Tsutsumi et al., 2017) with only 12 5 participants, so these outcomes should be treated with caution.

6 One paper explored the effects of exposure to the coast in Virtual Reality on experienced pain and 7 vividness of thoughts one week after the painful experience (Tanja-Dijkstra et al., 2018). In two studies (of 8 which one was the only randomized controlled trial) reported in the same paper (Tanja-Dijkstra et al., 9 2018), the authors found that exposure to a coast in Virtual Reality lowered pain experienced during a 10 painful experience, but that it did not alter how participants reported their experience one week later.

11 Cross-sectional 12 Eight of the eleven cross-sectional studies reported at least one positive relationship between blue space 13 exposure and mental health (Alcock et al., 2015; Amoly et al., 2014; Bryce et al., 2016; Dempsey et al., 14 2018; MacKerron et el., 2013; Pedersen et al., 2019; White et al., 2013a; White et al., 2013b), three studies 15 reported no significant relationship (Helbich et al., 2018; White et al., 2017a; Qiang et al., 2019), and one 16 study reported a negative relationship (Alcock et al., 2015). Two of the three studies that reported no 17 effects of blue space also investigated the relationship between green space exposures on the outcome 18 variable. One study investigating effects of nature on suicide rates (Helbich et al., 2018), reported a positive 19 relation between green space and suicide rate, whereas the other study found very limited evidence for a 20 relation between green space and wellbeing (White et al., 2017a).

21 Five studies looked at potential mental-health benefits of inland water (Alcock et al., 2015; MacKerron & 22 Mourato, 2013; Pedersen et al., 2019; White et al., 2013a; White et al., 2013b), and showed very mixed 23 results, with only weak evidence for positive relationships. The majority of studies in this category 24 investigated the relationship between mental health and the amount of freshwater available in the 25 proximity of the residence and mental health, and. None of them pointed towards beneficial effects (Alcock 26 et al., 2015; White et al., 2013a; White et al., 2013b). One experience sampling study investigated the 27 association between being in direct proximity of freshwater and momentary happiness (MacKerron & 28 Mourato, 2013). This study yielded a positive relationship, albeit less pronounced than the beneficial 29 association it found for the coast and happiness. Another cross-sectional study used a survey to investigate 30 different responses to three wetland areas in Sweden (Pedersen et al., 2019). One of these areas, in 31 Helsingborg, scored higher on some aspects of life satisfaction and affect. It should be noted that the 32 Helsingborg area was integrated within a residential zone, unlike the other two wetland areas that were 33 located far from it. This may have caused the better outcomes reported in the paper, as closer proximity 34 could facilitate a higher contact frequency.

35 The benefits of the coast were investigated from three different perspectives: having a sea view, proximity 36 to the coast, and beach attendance. Two studies looked at the effects of having a sea view (Dempsey et al., 37 2018; Qiang et al., 2019). One study reported that a better view of the sea was related to beneficial effects 38 on the prevalence of depression for the elderly, and this effect was more pronounced than proximity to the 39 coast (Dempsey et al., 2018). The other found no such relationship with the prevalence of a depressive 40 disorder or the amount of poor mental health days (Qiang et al., 2019). The latter study, however, had a 41 very low sample size. The authors report including only 13 samples.

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1 Proximity to the coast and mental health outcomes were tested in four studies (Dempsey et al., 2018; 2 Helbich et al., 2018; White et al., 2013a; White et al., 2017a), and one study investigated availability of 3 coast in the environment (Alcock et al., 2015). These studies rendered mixed results. Three reported a 4 positive relationship between coastal proximity and mental health; a lower prevalence of depression 5 (Dempsey et al., 2018); less mental distress (White et al., 2013a); and a lower odds of mental health 6 problems for people who had relocated to a location nearer to the coast (Alcock et al., 2015). This latter 7 finding was based on data from only 46 individuals (412 observations), as only a few people in the database 8 had relocated close to the coast within the study period. One of these three studies reported finding no 9 relationship of coastal proximity on life satisfaction (White et al., 2013a). One study reported a negative 10 relationship, -the only negative relationship found within the present systematic review, between mental 11 health and relocation to nearer the coast (Alcock et al., 2015). Again, this outcome was based on relatively 12 few participants (351 observations from 37 individuals).

13 Two studies did not find any relationship between coastal proximity and mental health. The first looked at 14 suicide rate (Helbich et al., 2018). A national database was used in this study, but the analysis used 15 municipalities as the unit of observation, whereas three other studies were conducted at the individual 16 level. This study was also the only cross-sectional study that was not conducted within the United Kingdom. 17 The second of these two studies examined wellbeing (White et al., 2017a). Three types of wellbeing were 18 assessed: evaluative, eudaimonic (which closely resembles life satisfaction - ‘How satisfied are you with 19 your life nowadays’), and experiential. . Experiential wellbeing was measured by asking panel members 20 how happy and anxious they felt the day before. Momentary mood did yield significant responses in the 21 experimental studies. However, unlike these studies, mood was not directly linked with a visit to the coast 22 in this study.

23 The studies that did investigate mental wellbeing related to visits to coastal areas yielded more consistent 24 results. Beneficial effects of visits to the coast were reported on momentary happiness (MacKerron & 25 Mourato, 2013), higher recalled restoration compared to the open countryside (White et al., 2013b). 26 Annual beach attendance was found to be related with better outcomes on some aspects of problematic 27 behaviour of school children. However, it was unrelated to ADHD symptoms (Amoly et al., 2014).

28 Qualitative 29 Studies including local residents often found they had an emotional attachment with blue spaces, both for 30 people living near the coast and for those living near inland water. For instance, the Rhine running through 31 the German cities of Düsseldorf and Cologne was seen as an essential part of daily life for this 23-year old 32 resident of Cologne: “The River Rhine, the water, yes, so for me it is the river. A river in the city, that is what 33 I always need, yes” (Volker & Kistemann, 2015, p. 202).

34 Being away from the coast made residents yearn to get back to it, but other participants also mentioned 35 that going to the beach and being close to the coast was like an escape experience, allowing them to get 36 away from daily hassles and struggles. As the quote from this male from the Southeast coast of England 37 illustrates: “the beach isn’t everything you have to attend to. It’s all the busyness and the noise that isn’t 38 there, and the fact that it is what it is, and there’s no advertising trying to sell you that.” (Bell, 2015, p. 10). 39 In a similar vein, respondents along the Rhine in Düsseldorf indicated that the river made them think of a 40 holiday (Volker & Kistemann, 2015): “I think of holiday”, “I appreciate the holiday flair”, “I think of wind, 41 water, vacation.”

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1 The coast provided a sense of space and scale that helped put things in perspective. Besides a sense of 2 space, fluidity of the blue space was often referred to as being an important element in this experience of 3 being away, and of clearing the head: “If I’m kind of upset about anything or if I just need to get away for a 4 bit, I find that being by water and just staring at the waves crashing in kind of washes your emotions away… 5 ” (Bell, 2015, p. 10).

6 The dynamics of water appeared very important in the aesthetic appreciation of blue space and the 7 restorative effects of being close to the water. Fluidity was mentioned for both inland water and the coast. 8 For instance, referring to the river Rhine a respondent mentioned: “simply by the wave motion […] you 9 simply feel a piece of freedom.” (Volker & Kistemann, 2015, p. 200). Fluidity was also mentioned in relation 10 to the dynamics of the sea, tidal movements and waves and the ability to clear the mind and de-stress: “It’s 11 forever moving, it’s restless, it’s beautiful… [] It’s a bit like flame watching, it’s beautiful, there are things 12 happening and it relaxes you and de-stresses you” (Bell et al., 2015, p.17). For some, just viewing the sea 13 was already a calming experience, but others preferred stormy weather and waves while sailing or surfing. 14 The daily fluctuations of the sea also provided a chance for contemplation. For instance, the tide and 15 fluidity of the sea helped some elderly residents of Hawaii to feel at peace and come to terms with the final 16 stages of life (Coleman et al., 2015).

17 The dynamics of the sea, and the potential dangers that it brings were embraced by some, but were also 18 perceived as a barrier by others to go to the coast. Other barriers mentioned relate to cold weather, 19 slipperiness of areas around canals, brown canal water being perceived as dirty, crowding of beaches, or a 20 fear of children falling into water when footpaths were close to a canal. Thus, not all respondents were 21 positive about blue space, as the quote of this teenager in reference to a canal illustrates: “boring, it’s just 22 water” (Pitt et al., 2018, p. 167).

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1 5. Discussion

2 The aim of this systematic review was to identify which types and characteristics of blue spaces in urban 3 and peri-urban contexts are (especially) beneficial for mental health. Results from three different types of 4 studies were examined: experimental, cross-sectional, and qualitative. The benefits of blue space is a new 5 field of research, which was also reflected in the relatively small set of studies that were included in the 6 review; twenty six studies with the ‘oldest’ paper dating from 2013.

7 5.1 Mental health benefits 8 Not all indicators of mental health were present in the systematic review. For instance, no studies 9 addressed effects on neurodegenerative diseases or schizophrenia. For some health outcomes (e.g., ADHD, 10 quality of life) there were only one or two studies. Most consistent beneficial associations of blue space 11 across categories were found in studies targeting affect and affective disorders, which were the most 12 common outcomes investigated by the studies in this review. Less consistent positive associations were 13 found for general mental health and life satisfaction. Only one study reported a negative effect of blue 14 space (salt water) on the mental health of people who had moved house and closer to the coast. However, 15 these analyses were based on a very low number of observations.

16 5.2 Blue space typologies 17 The majority of the studies investigated benefits of the coast and/or sea, and only a few focused on inland 18 water. Consequently, there was also only a small selection of potential inland water types represented in 19 the dataset: wetlands, rivers and canals, or the percentage of freshwater. For example, there were no data 20 for lakes, ponds, or streams. In addition, most studies investigated the effects of blue space types rather 21 than examining the characteristics of the blue space. No comparisons, for instance, were made between 22 wild or managed rivers, between sandy and rocky beaches, or between different colours of sand. There 23 were not enough studies in all blue space categories, especially inland waters, to formulate robust 24 recommendations.

25 5.3 Confidence of no bias for the included studies 26 For the experimental studies, blinding of participants and outcomes was especially weak, as was the lack of 27 representative sampling. A lack of representativeness is problematic because it precludes generalisation of 28 the outcomes to the population at large. Blinding participants to the environmental manipulation can 29 present a challenge when investigating effects of environmental interventions on participants, but blinding 30 of the outcome assessment and representative sampling are less problematic to realize and could (or even 31 better should) be implemented to help overcome these limitations. Only one study included in the review 32 adhered to the criteria for a randomized controlled trial. Cross-sectional studies generally scored better on 33 these criteria. A relatively high number of studies in this category used national database information (e.g., 34 panel or census data) combined with GIS or other land cover databases, which minimising bias associated 35 with not blinding participants appropriately. On the other hand, these analyses were based on the 36 proximity and/or availability of blue space and did not reveal any information concerning actual exposure in 37 terms of frequency and/or duration. Relations were thus sought between availability or proximity of blue 38 space as a proxy for exposure, rather than looking at actual exposure. Both experimental studies and cross- 39 sectional studies had their shortcomings, but there was considerable overlap in their study outcomes. The 40 qualitative studies generally scored low on the confidence of no bias, with especially stakeholder

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1 involvement scoring low. This may not be surprising, as this is a relatively new approach to qualitative 2 research. Triangulation in any shape or form (e.g., in research methods used or in the diversity of 3 researchers involved) is another important improvement to gain a more reliable image on the experiential 4 side of blue space benefits.

5 5.4 Differential effects coast versus inland waters 6 Based on the few studies included in the review, it seems that more pronounced and more consistent 7 benefits occurred for coastal exposure than for inland waters. Four cross-sectional studies looked at both 8 the coast and inland waters and all three studies yielded beneficial effects of the coast, whereas either no 9 effect was found for inland waters or effects were less pronounced. Again, it must be emphasized that only 10 a few studies investigated the benefits of inland water, and only a small proportion of potential inland 11 water types were considered. Previous studies investigating scenic beauty though, have often found better 12 scores for environments containing water features (Kaplan & Kaplan, 1989). In addition, from an 13 evolutionary perspective, the presence of water is also assumed to be a positive element (Ulrich, 1983). 14 Differences between these two categories may pertain to geographical and climatic diversity between the 15 two blue spaces, further research is necessary in order to understand the role of these two.

16 Benefits of coastal exposure were reported in all three study categories: experimental, cross-sectional, and 17 qualitative. Experimental and cross-sectional studies looking at direct exposure to the coast showed the 18 most consistent beneficial pattern on wellbeing, especially for affective outcomes. These studies all 19 investigated short-term effects during, or directly after, a visit. Cross-sectional studies taking availability as 20 a proxy for exposure to the coast rendered more mixed and less consistent results. These results may signal 21 a need for more studies looking at direct exposure rather than taking availability as a proxy. In fact, one 22 study combined availability analyses with frequency analyses (White et al., 2017a). Participants were asked 23 to report their mood in terms of happiness and anxiety for the day after a visit, and beneficial effects of 24 visit frequency (taking green and blue spaces together) were reported whereas no association was found of 25 coastal proximity (nor for amount of green) on experiential wellbeing (mood), carefully pointing at the 26 importance of actual exposure rather than mere availability.

27 Only a few studies directly compared benefits of different characteristics of blue space. One study found 28 that higher levels of biodiversity resulted in better mood while viewing a video of coastal scenery. 29 Qualitative studies further shed light on the important characteristics of blue space, citing the fluidity and 30 dynamics of the water. This was often mentioned as a means by which visitors clear their head, reduce 31 stress, or contemplate daily problems or existential issues. The dynamics of water were mentioned for both 32 coastal and inland blue space. Experimental studies reported a consistent beneficial effect of looking at 33 videos of the sea or exposure to the coast via Virtual Reality (Triguero-Mas et al., 2017; Tsutsumi et al., 34 2017). Only one study did not find this positive effect on affect (Emfield & Neider, 2014). As this study used 35 static images rather than videos, this result may add further weight to the benefits associated with the 36 dynamics of water.

37 Two qualitative studies investigated barriers to visiting the coast (Ashbullby et al., 2013) and a river/canal 38 (Pitt, 2018). Canals were sometimes perceived as dirty when they contained brown water, and people 39 indicated a fear of slippery surfaces and falling into the water, where the water was directly adjacent to the 40 footpath and indistinct visually. A teenager also commented that the water was just boring, providing 41 nothing to do. For the coast, people mentioned that you needed a car to get there, that cold weather was

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1 off putting and they were fearful of accidents due to the dangers of the sea. Conversely, stormy weather 2 and crushing waves appeared to also attract people to the beach and even into the water.

3 Additionally, the qualitative studies indicated that inhabitants of coastal areas, as well as visitors, find the 4 combination of sea and adjacent land (e.g. beaches, nature) beneficial in numerous ways, some of which 5 are linked to mental wellbeing. Many locals felt an emotional attachment with the blue spaces and some 6 also had strong associations of these spaces with holidays and recreation.

7 5.5 Pathways from blue space to mental health 8 Theoretically, the benefits of blue spaces are proposed to run through three different pathways: by 9 enhancing social interactions, facilitating physical activities, and reducing stress (restorative effects). The 10 majority of the experimental studies in this review used representations of nature and thereby focused 11 mainly on the restorative effects of nature, rather than the other two pathways. Cross-sectional studies 12 also did not include measures on social interaction or physical activity. Hence, the studies included in this 13 review shed little light on the pathways underpinning the beneficial effects of blue space on mental health. 14 In the qualitative studies, all three pathways were mentioned by participants in relation to the coast and 15 rivers and canals. These results should also be explored quantitatively.

16 Bratman and colleagues (2019) commented that in many empirical studies the ‘experience’ step is not 17 considered, which also appeared to have happened in the quantitative studies included in this review. For 18 example, they provided little insight in the specific sensory qualities of blue spaces. One experimental study 19 found benefits of blue space images, with and without sounds, on relaxation (Emfield & Neider, 2014). The 20 qualitative studies, again, provided insights in the experiential part of blue space exposure, referring to the 21 smell of water, the wind in your hair, waves crashing against your body, and the dynamics of tidal 22 movements and waves, reporting them as positive and often exhilarating experiences.

23 5.6 Limitations 24 The systematic review showed that there is a lack of high-quality papers on the topic of the request. 25 Whereas the experimental studies often lacked blinding and representativeness, the cross-sectional papers 26 often failed to measure direct exposure. In 2007, Velarde, Fry, and Tveit noted that in most experimental 27 studies on green space, only a crude distinction was made between natural and urban landscapes. In a 28 similar vein, in this systematic review we could also only make a crude distinction between coast and inland 29 waters. Research on inland water was limited to wetlands, freshwater, rivers and canals, and was not 30 representative of the wide range of inland blue spaces that are accessible to people. Furthermore, only a 31 few studies investigated the characteristics of blue space. Finally, a relatively large proportion of studies 32 were undertaken in one country, the United Kingdom, presenting a large geographical bias.

33 The aim of this systematic review was to provide information about blue spaces in urban and peri-urban 34 environments. Not all of the included studies were executed in these types of environments. In fact, most 35 studies related to the benefits of the coast. These outcomes are informative for urban and peri-urban 36 environments along the coastline, but do not directly translate to inland urban and peri-urban areas. This, 37 once again, stresses the importance of more research into potential inland water benefits for mental health 38 and wellbeing.

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1 6. Concluding remarks

2 In this systematic review, we set out to identify which types and characteristics of blue space in urban and 3 peri-urban areas are (especially) beneficial for mental wellbeing. Few high- quality papers were available, 4 and with little systematic variation in the type of blue space exposure studies investigated. Inland waters 5 were underrepresented, as were studies looking into the characteristics of blue spaces. This prevented us 6 from formulating firm conclusions and recommendations, other than future research is warranted. Few 7 benefits of rivers or canals could be identified, but coastal visits were consistently related to better 8 affective outcomes. The qualitative studies included in the systematic review provided insights into the 9 experiential characteristics of blue spaces which could guide future research, such as the unique dynamic 10 and fluid characteristic of water and the sense of visually open space.

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1 7. References

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1 Higgins, J. P., & Green, S. (2011). Cochrane handbook for systematic reviews of interventions (Vol. 4): John Wiley & 2 Sons. 3 Hignett, A., White, M. P., Pahl, S., Jenkin, R., Froy, M. L. J. J. o. A. E., & Learning, O. (2018). Evaluation of a surfing 4 programme designed to increase personal well-being and connectedness to the natural environment among ‘at 5 risk’young people. 18(1), 53-69. 6 Holt-Lunstad, J., Smith, T. B., & Layton, J. B. J. P. m. (2010). Social relationships and mortality risk: a meta-analytic 7 review. 7(7), e1000316. 8 Kaplan, S. J. J. o. e. p. (1995). The restorative benefits of nature: Toward an integrative framework. 15(3), 169-182. 9 Kaplan, R., & Kaplan, S. (1989). The experience of nature: A psychological perspective. CUP Archive. 10 Keniger, L. E., Gaston, K. J., Irvine, K. N., Fuller, R. A. J. I. j. o. e. r., & health, p. (2013). What are the benefits of 11 interacting with nature? , 10(3), 913-935. 12 Kellert, S. R., & Wilson, E. O. (Eds.). (1995). The biophilia hypothesis. Island Press. 13 Lovell, R., Husk, K., Cooper, C., Stahl-Timmins, W., & Garside, R. (2015). Understanding how environmental 14 enhancement and conservation activities may benefit health and wellbeing: a systematic review. BMC public 15 health, 15(1), 864. 16 MacKerron, G., & Mourato, S. (2013). Happiness is greater in natural environments. Global Environmental Change, 17 23(5), 992-1000. doi:10.1016/j.gloenvcha.2013.03.010 18 MEa, M. E. A. (2005). Ecosystems and human well-being: synthesis. Island, Washington, DC 19 Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Group, P. (2010). Preferred reporting items for systematic reviews 20 and meta-analyses: the PRISMA statement. In. 21 Nutsford, D., Pearson, A. L., Kingham, S., Reitsma, F. J. H., & place. (2016). Residential exposure to visible blue space 22 (but not green space) associated with lower psychological distress in a capital city. 39, 70-78. 23 Pedersen, E., Weisner, S. E. B., & Johansson, M. (2019). Wetland areas' direct contributions to residents' well-being 24 entitle them to high cultural ecosystem values. Science of the Total Environment, 646, 1315-1326. 25 Pitt, H. (2018). Muddying the waters: What urban waterways reveal about bluespaces and wellbeing. Geoforum, 92, 26 161-170. 27 Popay, J., Roberts, H., Sowden, A., Petticrew, M., Arai, L., Rodgers, M., . . . Duffy, S. J. A. p. f. t. E. m. p. V. (2006). 28 Guidance on the conduct of narrative synthesis in systematic reviews. 1, b92. 29 Qiang, Y., Shen, S., & Chen, Q. (2019). Visibility analysis of oceanic blue space using digital elevation models. 30 Landscape and Urban Planning, 181, 92-102. doi:10.1016/j.landurbplan.2018.09.019 31 Rogerson, M., Brown, D. K., Sandercock, G., Wooller, J.-J., & Barton, J. (2016). A comparison of four typical green 32 exercise environments and prediction of psychological health outcomes. Perspect Public Health, 136(3), 171-180. 33 doi:https://dx.doi.org/10.1177/1757913915589845 34 Srivastava, K. (2009). Urbanization and mental health. Industrial psychiatry journal, 18(2), 75. 35 Tanja-Dijkstra, K., Pahl, S., White, M. P., Auvray, M., Stone, R. J., Andrade, J., . . . Moles, D. R. (2018). The Soothing Sea: 36 A Virtual Coastal Walk Can Reduce Experienced and Recollected Pain. Environment and Behavior, 50(6), 599-625. 37 Taylor, L., Hochuli, D. F. J. L., & Planning, U. (2017). Defining greenspace: Multiple uses across multiple disciplines. 158, 38 25-38. 39 Triguero-Mas, M., Gidlow, C. J., Martínez, D., De Bont, J., Carrasco-Turigas, G., Martínez-Íñiguez, T., . . . Seto, E. J. P. o. 40 (2017). The effect of randomised exposure to different types of natural outdoor environments compared to 41 exposure to an urban environment on people with indications of psychological distress in Catalonia. 12(3), 42 e0172200. 43 Tsutsumi, M., Nogaki, H., Shimizu, Y., Stone, T. E., & Kobayashi, T. J. J. J. o. N. S. (2017). Individual reactions to viewing 44 preferred video representations of the natural environment: A comparison of mental and physical reactions. 45 14(1), 3-12.

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1 Ulrich, R. S. (1983). Aesthetic and affective response to natural environment. In Behavior and the natural environment 2 (pp. 85-125). Springer, Boston, MA. 3 Ulrich, R.S. (1993). Biophilia, biophobia, and natural landscapes. The biophilia hypothesis, 7, 73-137. 4 Ulrich, R. S., Simons, R. F., Losito, B. D., Fiorito, E., Miles, M. A., & Zelson, M. J. J. o. e. p. (1991). Stress recovery during 5 exposure to natural and urban environments. 11(3), 201-230. 6 Van den Bosch, M., & Sang, Å. O. J. E. r. (2017). Urban natural environments as nature-based solutions for improved 7 public health–A systematic review of reviews. 158, 373-384. 8 Volker, S., & Kistemann, T. (2015). Developing the urban blue: Comparative health responses to blue and green urban 9 open spaces in Germany. Health Place, 35, 196-205. 10 Völker, S., Kistemann, T. J. I. j. o. h., & health, e. (2011). The impact of blue space on human health and well-being– 11 Salutogenetic health effects of inland surface waters: A review. 214(6), 449-460. 12 White, M., Pahl, S., Wheeler, B., Fleming, L., & Depledge, M. J. (2016). The ‘Blue Gym’: What can blue space do for you 13 and what can you do for blue space? , 96(1), 5-12. 14 White, M. P., Alcock, I., Wheeler, B. W., & Depledge, M. H. (2013a). Coastal proximity, health and well-being: results 15 from a longitudinal panel survey. 23, 97-103. 16 White, M. P., Pahl, S., Ashbullby, K., Herbert, S., & Depledge, M. H. (2013b). Feelings of restoration from recent nature 17 visits. Journal of Environmental Psychology, 35, 40-51. 18 White, M. P., Pahl, S., Wheeler, B. W., Depledge, M. H., & Fleming, L. E. (2017a). Natural environments and subjective 19 wellbeing: Different types of exposure are associated with different aspects of wellbeing. Health & Place, 45, 77- 20 84. 21 White, M. P., Weeks, A., Hooper, T., Bleakley, L., Cracknell, D., Lovell, R., & Jefferson, R. L. (2017b). Marine wildlife as 22 an important component of coastal visits: The role of perceived biodiversity and species behaviour. Marine 23 Policy, 78, 80-89. 24 WHO (1992). The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic 25 guidelines. Geneva: World Health Organization. 26 WHO (2014). Mental health: a state of well-being. 2014. Report of the WHO Department of Mental Health. 27 WHO (2016). “Healthy cities” www.euro.who.int/en/health-topics/environment-and-health/urban- 28 health/activities/healthy-cities, last accessed 17-01-2020 29 WHO (2017). Water, health and Ecosystems. http://www.who.int/heli/risks/water/water/en/, last accessed 17-01- 30 2020 31 Willis, C. (2015). A human needs approach to revealing nature's benefits for visitors to the coast. Area, 47(4), 422-428. 32 Zürcher, N., & Andreucci, M.-B. (2017). Growing the Urban Forest: Our Practitioners’ Perspective. In The Urban Forest 33 (pp. 315-346): Springer. 34

EKLIPSE – Blue spaces and mental health and wellbeing 49 of 77

1 Appendix A – Full search strategies

2 Database: Ovid MEDLINE ALL <1946 to November 28, 2018>

4 Interface / URL: OvidSP

5 Database coverage dates: 1946 to November 28, 2018

6 Search date: 29 November 2018

7 Retrieved records: 6774

8 Search strategy:

10 1 lakes/ or ponds/ or rivers/ (29562)

11 2 Wetlands/ (6364)

12 3 exp "oceans and seas"/ (32218)

13 4 (blue adj5 (space$ or area$1 or zone$1 or corridor$ or connector$ or landscap$ or environment$1 or 14 architecture$ or infrastructure$ or design$)).ti,ab,kf. (1838)

15 5 bluespace$.ti,ab,kf. (5)

16 6 (blue adj5 (urban$ or neighbourhood$ or neighborhood$ or community or communities or city or cities 17 or town or towns or suburb$ or semiurban or periurban or semisuburban or residential or municipal or 18 metropolitan or metropolis$)).ti,ab,kf. (159)

19 7 ((sustainable adj3 drain$) or water-sensitive urban design$).ti,ab,kf. (122)

20 8 (water feature$ or water mirror$ or (water$ adj3 sound$) or water surface$ or (water$ adj3 (body or 21 bodies)) or water fall$ or waterfall$ or falling water$ or flowing water$ or water park$ or waterpark$ or 22 water way$ or waterway$ or waterscape$ or water-scape$ or waterside$ or water-side$ or water front$ or 23 waterfront$ or water course$ or watercourse$ or watershed$ or water shed$).ti,ab,kf. (28153)

24 9 (water$ adj5 (urban$ or neighbourhood$ or neighborhood$ or community or communities or city or 25 cities or town or towns or suburb$ or semiurban or periurban or semisuburban or residential or municipal 26 or metropolitan or metropolis$)).ti,ab,kf. (10808)

27 10 (water$ adj3 (expose$ or exposure$ or interact$ or proximity or vicinity or vicinities or distance$ or 28 location$1)).ti,ab,kf. (16701)

29 11 (aquatic or subaquatic or beach or beaches or bog or bogs or brook or brooks or canal or canals or 30 coast or coasts or coastal or creek$1 or dock or docks or estuary or estuaries or fjord$ or flood plain$ or 31 floodplain$ or fountain$).ti. (57830)

EKLIPSE – Blue spaces and mental health and wellbeing 50 of 77

1 12 ((aquatic or subaquatic or beach or beaches or bog or bogs or brook or brooks or canal or canals or 2 coast or coasts or coastal or creek$1 or dock or docks or estuary or estuaries or fjord$ or flood plain$ or 3 floodplain$ or fountain$) adj5 (urban$ or neighbourhood$ or neighborhood$ or community or 4 communities or city or cities or town or towns or suburb$ or semiurban or periurban or semisuburban or 5 residential or municipal or metropolitan or metropolis$)).ab,kf. (4981)

6 13 ((aquatic or subaquatic or beach or beaches or bog or bogs or canal or canals or coast or coasts or 7 coastal or creek$1 or dock or docks or estuary or estuaries or fjord$ or flood plain$ or floodplain$ or 8 fountain$) adj3 (expose$ or exposure$ or interact$ or proximity or vicinity or vicinities or distance$ or 9 location$1)).ab,kf. (2954)

10 14 (harbor or harbors or harbour or harbours or hydrographic or island$1 or lagoon$1 or lake or lakes or 11 marina or marinas or marsh or marshes or marshland$).ti. (44446)

12 15 ((harbor or harbors or harbour or harbours or hydrographic or island$ or lagoon$1 or lake or lakes or 13 marina or marinas or marsh or marshes or marshland$) adj5 (urban$ or neighbourhood$ or neighborhood$ 14 or community or communities or city or cities or town or towns or suburb$ or semiurban or periurban or 15 semisuburban or residential or municipal or metropolitan or metropolis$)).ab,kf. (5330)

16 16 ((harbor or harbors or harbour or harbours or hrographic or island$1 or lagoon$1 or lake or lakes or 17 marina or marinas or marsh or marshes or marshland$) adj3 (expose$ or exposure$ or interact$ or 18 proximity or vicinity or vicinities or distance$ or location$1)).ab,kf. (1608)

19 17 (ocean$1 or pond$1 or pool or pools or port or ports or riparian or river or rivers or riverside or 20 riverbank$ or riverfront$ or rockpool$ or rock pool$ or sea or seas or seashore$ or stream or streams or 21 wetland$ or wet land$).ti. (93123)

22 18 ((ocean$1 or pond$1 or pool or pools or port or ports or riparian or river or rivers or riverside or 23 riverbank$ or riverfront$ or rockpool$ or rock pool$ or sea or seas or seashore$ or stream or streams or 24 wetland$ or wet land$) adj5 (urban$ or neighbourhood$ or neighborhood$ or community or communities 25 or city or cities or town or towns or suburb$ or semiurban or periurban or semisuburban or residential or 26 municipal or metropolitan or metropolis$)).ab,kf. (6873)

27 19 ((ocean$1 or pond$1 or pool or pools or port or ports or riparian or river or rivers or riverside or 28 riverbank$ or riverfront$ or rockpool$ or rock pool$ or sea or seas or seashore$ or stream or streams or 29 wetland$ or wet land$) adj3 (expose$ or exposure$ or interact$ or proximity or vicinity or vicinities or 30 distance$ or location$1)).ab,kf. (3936)

31 20 or/1-19 (271190)

32 21 Mental Health/ (32271)

33 22 exp mental disorders/ or mentally ill persons/ (1146247)

34 23 quality-adjusted life years/ or "quality of life"/ or "value of life"/ (181911)

35 24 aggression/ or delusions/ or depersonalization/ or depression/ or exp stress, psychological/ or mental 36 fatigue/ or problem behavior/ or exp self-injurious behavior/ or anxiety/ (349331)

EKLIPSE – Blue spaces and mental health and wellbeing 51 of 77

1 25 ((mental$ or psychological$ or psychiatric) adj3 (fatigue$ or disease$ or disorder$ or illness$ or 2 diagnos$ or wellbeing or well-being or hygiene or satisf$ or stress$ or wellness$ or resilien$)).ti,ab,kf. 3 (173905)

4 26 ((mental or psychological or psychiatric) adj health).ti,ab,kf. (132084)

5 27 (wellbeing or well-being).ti. (13203)

6 28 (mentally ill or mentally unwell).ti,ab,kf. (7538)

7 29 ((psychological$ or psychiatric or psychotherapeutic) adj3 (impact$ or outcome$1 or effect$1 or 8 benefit$ or value$)).ti,ab,kf. (22160)

9 30 (behavio?r$ adj (disorder$1 or illness$1 or disease$1)).ti,ab,kf. (10499)

10 31 (quality of life or quality adjusted life or QOL or QALY or QALYs or HRQOL).ti,ab,kf. (243814)

11 32 (disability adjusted life or DALY or DALYS).ti,ab,kf. (3197)

12 33 (utility adj3 (score$1 or valu$ or health$ or cost$ or measur$ or disease$ or mean or gain or gains or 13 index$)).ti,ab,kf. (13077)

14 34 (health state utilit$ or utilities or HSUV$1).ti,ab,kf. (6479)

15 35 addiction.ti,ab,kf. (41362)

16 36 (adhd or attention deficit or hyperactiv$).ti,ab,kf. (59256)

17 37 (aggression or aggressive$ or aggressivity).ti,ab,kf. (186450)

18 38 (dement$ or amentia$ or senile or senility or presenile or presenility or alzheimer$).ti,ab,kf. (204321)

19 39 ((cognitiv$ or cognition or neurocognit$ or mental) adj3 (declin$ or dysfunction$ or impair$ or 20 disorder$ or deteriorat$ or function)).ti,ab,kf. (174524)

21 40 (neurodegenerative adj (illness$ or disorder$ or disease$)).ti,ab,kf. (60439)

22 41 ((affective or body dysmorphic or cyclothymic or deficit or depersonalization or depersonalisation or 23 depressive or developmental or dissociative or dysthymic or emotional or factitious or mood or obsessive- 24 compulsive or panic or sleep$) adj disorder$1).ti,ab,kf. (104134)

25 42 (depression or depressive illness$ or anxiety or anxieties or anxious$ or agoraphobi$ or phobia$ or 26 phobic).ti,ab,kf. (412258)

27 43 (amnesia or autism or autistic or bipolar or bi-polar or manic depressive or mania).ti,ab,kf. (115088)

28 44 (bore$ out or boreout$ or brown$ out or brownout$ or burn$ out or burnout$).ti,ab,kf. (9982)

29 45 (emotional adj3 (wellbeing or well-being or regulat$)).ti,ab,kf. (7916)

30 46 (happiness or peace of mind or serenity or relaxing or relaxation).ti,ab,kf. (124226)

31 47 (attention restoration or restorative or restorativeness).ti,ab,kf. (19971)

EKLIPSE – Blue spaces and mental health and wellbeing 52 of 77

1 48 (insomnia or insomniac$ or sleep quality or somatisation or somatization or somatoform).ti,ab,kf. 2 (34964)

3 49 mental aging.ti,ab,kf. (33)

4 50 ((belonging$ or coherence) adj3 sense).ti,ab,kf. (2743)

5 51 (subjective wellbeing or subjective well-being or vitality).ti,ab,kf. (13719)

6 52 (paranoia or psychosis or psychotic or schizophreni$ or suicide$ or suicidal).ti,ab,kf. (217351)

7 53 (stress adj3 (disorder$1 or illness$ or trauma$ or posttrauma$ or acute or chronic$ or episod$ or 8 emotional or occupational or psychologic$ or recover$ or reduc$)).ti,ab,kf. (99481)

9 54 salutogenetic$.ti,ab,kf. (70)

10 55 or/21-54 (2493722)

11 56 20 and 55 (7788)

12 57 exp animals/ not humans/ (4519948)

13 58 (news or comment or editorial or letter or case reports).pt. or case report.ti. (3615358)

14 59 56 not (57 or 58) (5754)

15 60 remove duplicates from 59 (5749)

16 61 (blue adj5 (space$ or area$1 or zone$1 or corridor$ or connector$ or landscap$ or environment$1 or 17 architecture$ or infrastructure$ or design$)).ti,ab,kf. (1838)

18 62 bluespace$.ti,ab,kf. (5)

19 63 (blue adj5 (urban$ or neighbourhood$ or neighborhood$ or community or communities or city or 20 cities or town or towns or suburb$ or semiurban or periurban or semisuburban or residential or municipal 21 or metropolitan or metropolis$)).ti,ab,kf. (159)

22 64 ((sustainable adj3 drain$) or water-sensitive urban design$).ti,ab,kf. (122)

23 65 (water feature$ or water mirror$ or (water$ adj3 sound$) or water surface$ or (water$ adj3 (body or 24 bodies)) or water fall$ or waterfall$ or falling water$ or flowing water$ or water park$ or waterpark$ or 25 water way$ or waterway$ or waterscape$ or water-scape$ or waterside$ or water-side$ or water front$ or 26 waterfront$ or water course$ or watercourse$ or watershed$ or water shed$).ti,ab,kf. (28153)

27 66 (water$ adj5 (urban$ or neighbourhood$ or neighborhood$ or community or communities or city or 28 cities or town or towns or suburb$ or semiurban or periurban or semisuburban or residential or municipal 29 or metropolitan or metropolis$)).ti,ab,kf. (10808)

30 67 (water$ adj3 (expose$ or exposure$ or interact$ or proximity or vicinity or vicinities or distance$ or 31 location$1)).ti,ab,kf. (16701)

EKLIPSE – Blue spaces and mental health and wellbeing 53 of 77

1 68 (aquatic or subaquatic or beach or beaches or bog or bogs or brook or brooks or canal or canals or 2 coast or coasts or coastal or creek$1 or dock or docks or estuary or estuaries or fjord$ or flood plain$ or 3 floodplain$ or fountain$ or freshwater or saltwater).ti,ab,kf. (210867)

4 69 (harbor or harbors or harbour or harbours or hydrographic or island$1 or lagoon$1 or lake or lakes or 5 marina or marinas or marsh or marshes or marshland$).ti,ab,kf. (159214)

6 70 (ocean$1 or pond$1 or pool or pools or port or ports or riparian or river or rivers or riverside or 7 riverbank$ or riverfront$ or rockpool$ or rock pool$ or sea or seas or seashore$ or stream or streams or 8 wetland$ or wet land$).ti,ab,kf. (338507)

9 71 (mental or psychological or wellbeing or well being or restoration).ti. (170457)

10 72 or/61-70 (672118)

11 73 71 and 72 (2293)

12 74 73 not (57 or 58) (1929)

13 75 remove duplicates from 74 (1928)

14 76 60 or 75 (7309)

15 77 limit 76 to english language (6774)

EKLIPSE – Blue spaces and mental health and wellbeing 54 of 77

1 Database: Web of Science – citation indexes only

2 Interface / URL: http://apps.webofknowledge.com.

3 Database coverage dates: Timespan=1900-2018

4 Search date: 29 November 2018

5 Retrieved records: 20099

6 Search strategy:

# 40 20,099 (#38) AND LANGUAGE: (English) AND DOCUMENT TYPES: (Article) Refined by: [excluding] WEB OF SCIENCE CATEGORIES: ( GEOSCIENCES MULTIDISCIPLINARY OR CHEMISTRY PHYSICAL OR GEOGRAPHY PHYSICAL OR FISHERIES ) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 39 24,160 (#38) AND LANGUAGE: (English) AND DOCUMENT TYPES: (Article) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 38 27,133 #37 OR #32 Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 37 7,037 #36 AND #35 Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 36 2,041,520 #34 OR #33 Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 35 257,476 TI=(“mental” OR “psychological” OR “wellbeing” OR “well being” OR “restoration”) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 34 1,941,585 TS=(“aquatic” OR “subaquatic” OR “beach” OR “beaches” OR “bog” OR “bogs” OR “canal” OR “canals” OR “coast” OR “coasts” OR “coastal” OR “creek$” OR “dock” OR “docks” OR “estuary” OR “estuaries” OR “fjord$” OR “flood plain$” OR “floodplain$” OR “fountain$” OR “harbOR “OR “harbors” OR “harbour” OR “harbours” OR “hydrographic” OR “island$” OR “lagoon$” OR “lake” OR “lakes” OR “marina” OR “marinas” OR “marsh” OR “marshes” OR “marshland$” OR “ocean$” OR “pond$” OR “pool” OR “pools” OR “port” OR “ports” OR “riparian” OR “river” OR “rivers” OR “riverside” OR “riverbank$” OR “riverfront$” OR “rockpool$” OR “rock pool$” OR “sea” OR “seas” OR “seashore$” OR “stream” OR “streams” OR “wetland$” OR “wet land$”) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 33 179,710 #7 OR #6 OR #5 OR #4 OR #3 OR #2 OR #1 Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 32 20,618 #31 AND #17 Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 31 2,690,825 #30 OR #29 OR #28 OR #27 OR #26 OR #25 OR #24 OR #23 OR #22 OR #21 OR #20 OR #19 OR #18 Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

EKLIPSE – Blue spaces and mental health and wellbeing 55 of 77

# 30 150,789 TS=(“stress” NEAR/3 (“disorder$” OR “illness$” OR “trauma*” OR “posttrauma*” OR “acute” OR “chronic$” OR “episode$” OR “emotional” OR “occupational” OR “psychologic*” OR “recover*” OR “reduc*”)) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 29 309,086 TS=(“subjective wellbeing” OR “subjective well-being” OR “vitality” OR “paranoia” OR “psychosis” OR “psychotic” OR “schizophreni$” OR “suicide$” OR “suicidal” OR salutogenetic$) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 28 4,489 TS=((“belonging$” OR “coherence”) NEAR/3 “sense”) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 27 440,111 TS=(“happiness” OR (“peace” NEAR/3 “mind”) OR “serenity” OR “relaxing” OR “relaxation” OR “attention restoration” OR “restorative” OR “restorativeness” OR “insomnia” OR “insomniac$” OR “sleep quality” OR “somatisation” OR “somatization” OR “somatoform” OR “mental aging”) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 26 9,724 TS=(“emotional” NEAR/3 (“wellbeing” OR “well-being” OR “regulat*”)) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 25 951,655 TS=(affective DISORDER$ OR body dysmorphic DISORDER$ OR cyclothymic DISORDER$ OR deficit DISORDER$ OR depersonalization DISORDER$ OR depersonalisation DISORDER$ OR depressive DISORDER$ OR developmental DISORDER$ OR dissociative DISORDER$ OR dysthymic DISORDER$ OR emotional DISORDER$ OR factitious DISORDER$ OR mood DISORDER$ OR obsessive- compulsive DISORDER$ OR panic DISORDER$ OR sleep DISORDER$ OR depression OR depressive illness$ OR anxiety OR anxieties OR anxious* OR agoraphobi$ OR phobia$ OR phobic OR amnesia OR autism OR autistic OR bipolar OR bi-polar OR manic depressive OR mania OR bore$ out OR boreout$ OR brown$ out OR brownout$ OR burn* out OR burnout$) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 24 67,260 TS=(“neurodegenerative” NEAR/1 (“illness$” OR “disorder$” OR “disease$”)) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 23 207,634 TS=((“cognitive*” OR “cognition” OR “neurocognit*” OR “mental”) NEAR/3 (“declin*” OR “dysfunction*” OR “impair*” OR “disorder*” OR “deteriorate*” OR “function”)) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 22 602,085 TS=(“health state utilit$” OR “utilities” OR “HSUV$” OR ”addiction” OR “adhd” OR “attention deficit” OR “hyperactive” OR “aggression” OR “aggressive$” OR “aggressivity” OR “dement*” OR “amentia$” OR “senile” OR “senility” OR “presenile” OR “presenility” OR “alzheimer$”) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 21 21,063 TS=(“utility” NEAR/3 (“score$” OR “valu*” OR “health$” OR “cost$” OR “measure*” OR “disease$” OR “mean” OR “gain” OR “gains” OR “index*”)) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 20 325,859 TS=((“quality” NEAR/2 “life”) OR “quality adjusted Life” OR “QOL” OR “QALY” OR “QALYs” OR “HRQOL” OR “disability adjusted life” OR “DALY” OR “DALYS”) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

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# 19 31,153 TS=(((“psychological$” OR “psychiatric” OR “psychotherapeutic”) NEAR/3 (“impact$” OR “outcome$” OR “effect$” OR “benefit$” OR “value$”)) OR (“behavio?r$” NEAR/1 (“disorder$” OR “illness$” OR “disease$”))) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 18 396,383 TS=((mental$ OR psychological$ OR psychiatric) NEAR/3 (fatigue$ OR disease$ OR disorder$ OR illness$ OR diagnos* OR wellbeing OR well-being OR hygiene OR satisfy* OR stress* OR wellness$ OR resilien$) OR ((mental OR psychological OR psychiatric) NEAR/1 health) OR(wellbeing OR well-being OR mentally ill OR mentally unwell)) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 17 984,435 #16 OR #15 OR #14 OR #13 OR #12 OR #11 OR #10 OR #9 OR #8 OR #7 OR #6 OR #5 OR #4 OR #3 OR #2 OR #1 Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 16 22,883 AB=((“ocean$” OR “pond$” OR “pool” OR “pools” OR “port” OR “ports” OR “riparian” OR “river” OR “rivers” OR “riverside” OR “riverbank$” OR “riverfront$” OR “rockpool$” OR “rock pool$” OR “sea” OR “seas” OR “seashore$” OR “stream” OR “streams” OR “wetland$” OR “wet land$”) NEAR/3 (“expose$” OR “exposure$” OR “interact*” OR “proximity” OR “vicinity” OR “vicinities” OR “distance$” OR “location$”)) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 15 23,637 AB=((“ocean$” OR “pond$” OR “pool” OR “pools” OR “port” OR “ports” OR “riparian” OR “river” OR “rivers” OR “riverside” OR “riverbank$” OR “riverfront$” OR “rockpool$” OR “rock pool$” OR “sea” OR “seas” OR “seashore$” OR “stream” OR “streams” OR “wetland$” OR “wet land$”) NEAR/5 (“urban*” OR “neighbourhood$” OR “neighborhood$” OR “community” OR “communities” OR “city” OR “cities” OR “town” OR “towns” OR “suburb*” OR “semiurban” OR “periurban” OR “semisuburban” OR “residential” OR “municipal” OR “metropolitan” OR “metropolis$”)) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 14 461,135 TI=(“ocean$” OR “pond$” OR “pool” OR “pools” OR “port” OR “ports” OR “riparian” OR “river” OR “rivers” OR “riverside” OR “riverbank$” OR “riverfront$” OR “rockpool$” OR “rock pool$” OR “sea” OR “seas” OR “seashore$” OR “stream” OR “streams” OR “wetland$” OR “wet land$”) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 13 8,349 AB=((“harbOR“ OR “harbors” OR “harbour” OR “harbours” OR “hYDrographic” OR “island$” OR “lagoon$” OR “lake” OR “lakes” OR “marina” OR “marinas” OR “marsh” OR “marshes” OR “marshland$”) NEAR/3 (“expose$” OR “exposure$” OR “interact*” OR “proximity” OR “vicinity” OR “vicinities” OR “distance$” OR “location$”)) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 12 15,300 AB=((“harbOR“ OR “harbors” OR “harbour” OR “harbours” OR “hydrographic” OR “island$” OR “lagoon$” OR “lake” OR “lakes” OR “marina” OR “marinas” OR “marsh” OR “marshes” OR “marshland$”) NEAR/5 (“urban*” OR “neighbourhood$” OR “neighborhood$” OR “community” OR “communities” OR “city” OR “cities” OR “town” OR “towns” OR “suburb*” OR “semiurban” OR “periurban” OR “semisuburban” OR “residential” OR “municipal” OR “metropolitan” OR “metropolis$”)) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

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# 11 202,543 TI=(“harbOR“ OR “harbors” OR “harbour” OR “harbours” OR “hydrographic” OR “island$” OR “lagoon$” OR “lake” OR “lakes” OR “marina” OR “marinas” OR “marsh” OR “marshes” OR “marshland$”) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 10 11,259 AB=((“aquatic” OR “subaquatic” OR “beach” OR “beaches” OR “bog” OR “bogs” OR “canal” OR “canals” OR “coast” OR “coasts” OR “coastal” OR “creek$” OR “dock” OR “docks” OR “estuary” OR “estuaries” OR “fjord$” OR “flood plain$” OR “floodplain$” OR “fountain$”) NEAR/3 (“expose$” OR “exposure$” OR “interact*” OR “proximity” OR “vicinity” OR “vicinities” OR “distance$” OR “location$”)) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 9 17,112 AB=((“aquatic” OR “subaquatic” OR “beach” OR “beaches” OR “bog” OR “bogs” OR “brook” OR “brooks” OR “canal” OR “canals” OR “coast” OR “coasts” OR “coastal” OR “creek$” OR “dock” OR “docks” OR “estuary” OR “estuaries” OR “fjord$” OR “flood plain$” OR “floodplain$” OR “fountain$”) NEAR/5 (“urban*” OR “neighbourhood$” OR “neighborhood$” OR “community” OR “communities” OR “city” OR “cities” OR “town” OR “towns” OR “suburb*” OR “semiurban” OR “periurban” OR “semisuburban” OR “residential” OR “municipal” OR “metropolitan” OR “metropolis$”)) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 8 187,926 TI=(“aquatic” OR “subaquatic” OR “beach” OR “beaches” OR “bog” OR “bogs” OR “brook” OR “brooks” OR “canal” OR “canals” OR “coast” OR “coasts” OR “coastal” OR “creek$” OR “dock” OR “docks” OR “estuary” OR “estuaries” OR “fjord$” OR “flood plain$” OR “floodplain$” OR “fountain$”) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 7 50,773 TS=(“water$” NEAR/3(“expose$” OR “exposure$” OR “interact*” OR “proximity” OR “vicinity” OR “vicinities” OR “distance$” OR “location$”)) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 6 32,104 TS=(“water$” NEAR/5 (“urban*” OR “neighbourhood$” OR “neighborhood$” OR “community” OR “communities” OR “city” OR “cities” OR “town” OR “towns” OR “suburb*” OR “semiurban” OR “periurban” OR “semisuburban” OR “residential” OR “municipal” OR “metropolitan” OR “metropolis$”)) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 5 98,687 TS=(“water feature$” OR “water mirror$” OR (“water$” NEAR/3 “sound$”) OR “water surface$” OR (“water$” NEAR/3 (“body” OR “bodies”)) OR “water fall$” OR “waterfall$” OR “falling water$” OR “flowing water$” OR “water park$” OR “waterpark$” OR “water way$” OR “waterway$” OR “waterscape$” OR “waterscape$” OR “waterside$” OR “water side$” OR “water front$” OR “waterfront$” OR “water course$” OR “watercourse$” OR “watershed$” OR “water shed$”) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 4 480 TS=((“sustainable” NEAR/3 “drain*”) OR “water-sensitive urban design$”) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 3 558 TS=(“blue” NEAR/5 (“urban*” OR “neighbourhood$” OR “neighborhood$” OR “community” OR “communities” OR “city” OR “cities” OR “town” OR “towns” OR “suburb*” OR “semiurban” OR “periurban” OR “semisuburban” OR “residential” OR “municipal” OR “metropolitan” OR “metropolis$”)) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

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# 2 10 TS=(“bluespace$”) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018

# 1 4,579 TS=(blue NEAR/5 (space$ OR area$ OR zone$ OR corridor$ OR connector$ OR landscap* OR environment* OR architecture$ OR infrastructure$ OR design$)) Indexes=SCI-EXPANDED, SSCI, A&HCI Timespan=1900-2018 1

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1 Database: Scopus 2 Interface / URL: www.scopus.com 3 Database coverage dates: 4 Search date: 7 February 2019 5 Retrieved records: 47 6 Search strategy 7 8 1 ( ( ( ( ABS ( ( "ocean*" OR "pond*" OR "pool" OR "pools" OR "port" OR "ports 47 2 " OR "riparian" OR "river" OR "rivers" OR "riverside" OR "riverbank*" OR "ri document verfront*" OR "rockpool*" OR "rock results pool*" OR "sea" OR "seas" OR "seashore*" OR "stream" OR "streams" OR " wetland*" OR "wet land*" ) W/3 ( "expose*" OR "exposure*" OR "interact*" OR "proximity" OR " vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( ABS ( ( "ocean* " OR "pond*" OR "pool" OR "pools" OR "port" OR "ports" OR "riparian" OR "river" OR "rivers" OR "riverside" OR "riverbank*" OR "riverfront*" OR "rockp ool*" OR "rock pool*" OR "sea" OR "seas" OR "seashore*" OR "stream" OR "streams" OR " wetland*" OR "wet land*" ) W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "com munity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "residentia l" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE ( "ocean *" OR "pond*" OR "pool" OR "pools" OR "port" OR "ports" OR "riparian" OR "river" OR "rivers" OR "riverside" OR "riverbank*" OR "riverfront*" OR "rock pool*" OR "rock pool*" OR "sea" OR "seas" OR "seashore*" OR "stream" OR "streams" OR " wetland*" OR "wet land*" ) ) OR ( ABS ( ( "harbOR" OR "harbors" OR "harbour" OR "harbours" OR "hYDrographic" OR "island*" OR "lagoon*" OR "lake" OR "lakes" OR "marina " OR "marinas" OR "marsh" OR "marshes" OR "marshland*" ) W/3 ( "expose* " OR "exposure*" OR "interact*" OR "proximity" OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( ABS ( ( "harbor" OR "harbors" OR "har bour" OR "harbours" OR "hydrographic" OR "island*" OR "lagoon*" OR "lake " OR "lakes" OR "marina" OR "marinas" OR "marsh" OR "marshes" OR "mars hland*" ) W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "co mmunity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" O R "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "residen tial" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE ( "har bor" OR "harbors" OR "harbour" OR "harbours" OR "hydrographic" OR "islan d*" OR "lagoon*" OR "lake" OR "lakes" OR "marina" OR "marinas" OR "mars h" OR "marshes" OR "marshland*" ) ) OR ( ABS ( ( "aquatic" OR "subaquatic" OR "beach" OR "beaches" OR "bog" OR "bogs" OR "canal" OR "canals" OR " coast" OR "coasts" OR "coastal" OR "creek*" OR "dock" OR "docks" OR "est uary" OR "estuaries" OR "fjord*" OR "flood plain*" OR "floodplain*" OR "fountain*" ) W/3 ( "expose*" OR "exposure*" O R "interact*" OR "proximity" OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( ABS ( ( "aquatic" OR "subaquatic" OR "beach" OR "beache s" OR "bog" OR "bogs" OR "brook" OR "brooks" OR "canal" OR "canals" OR

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"coast" OR "coasts" OR "coastal" OR "creek*" OR "dock" OR "docks" OR "est uary" OR "estuaries" OR "fjord*" OR "flood plain*" OR "floodplain*" OR "fountain*" ) W/5 ( "urban*" OR "neighbourhood *" OR "neighborhood*" OR "community" OR "communities" OR "city" OR "cit ies" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" O R "semisuburban" OR "residential" OR "municipal" OR "metropolitan" OR "m etropolis*" ) ) ) OR ( TITLE ( "aquatic" OR "subaquatic" OR "beach" OR "beache s" OR "bog" OR "bogs" OR "brook" OR "brooks" OR "canal" OR "canals" OR "coast" OR "coasts" OR "coastal" OR "creek*" OR "dock" OR "docks" OR "est uary" OR "estuaries" OR "fjord*" OR "flood plain*" OR "floodplain*" OR "fountain*" ) ) OR ( TITLE-ABS- KEY ( "water*" W/3 ( "expose*" OR "exposure*" OR "interact*" OR "proximity " OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( TITLE- ABS- KEY ( "water*" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "community" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "resid ential" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "water feature*" OR "water mirror*" OR ( "water*" W/3 "sound*" ) OR "water surface*" OR ( "water*" W/3 ( "body" OR "bodies" ) ) OR "water fall*" OR "waterfall*" OR "falling water*" OR "flowing water*" OR "water park*" OR "waterpark*" OR "water way*" OR "waterway*" OR "waterscape*" OR "waterscape*" OR "waterside*" OR "water side*" OR "water front*" OR "waterfront*" OR "water course*" OR "watercourse*" OR "watershed*" OR "water shed*" ) ) OR ( TITLE-ABS-KEY ( ( "sustainable" W/3 "drain*" ) OR "water- sensitive urban design*" ) ) OR ( TITLE-ABS- KEY ( "blue" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "c ommunity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "reside ntial" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "bluespace*" ) ) OR ( TITLE-ABS- KEY ( blue W/5 ( space* OR area* OR zone* OR corridor* OR connector* OR landscap* OR environment* OR architecture* OR infrastructure* OR design* ) ) ) ) AND ( ( TITLE-ABS- KEY ( "stress" W/3 ( "disorder*" OR "illness*" OR "trauma*" OR "posttrauma* " OR "acute" OR "chronic*" OR "episode*" OR "emotional" OR "occupational " OR "psychologic*" OR "recover*" OR "reduc*" ) ) ) OR ( TITLE-ABS- KEY ( "subjective wellbeing" OR "subjective wellbeing" OR "vitality" OR "paranoia" OR "psychosis" OR "psychotic" OR "schizo phreni*" OR "suicide*" OR "suicidal" OR salutogenetic* ) ) OR ( TITLE-ABS- KEY ( ( "belonging*" OR "coherence" ) W/3 "sense" ) ) OR ( TITLE-ABS- KEY ( "happiness" OR ( "peace" W/3 "mind" ) OR "serenity" OR "relaxing" OR "relaxation" OR "attention restoration" OR "restorative" OR "restorativeness" OR "insomnia" OR "insomn iac*" OR "sleep quality" OR "somatisation" OR "somatization" OR "somatoform" OR "mental aging" ) ) OR ( TITLE-ABS-KEY ( "emotional" W/3 ( "wellbeing" OR "well-

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being" OR "regulat*" ) ) ) OR ( TITLE-ABS-KEY ( "affective DISORDER*" OR "body dysmorphic DISORDER*" OR "cyclothymic DISORDER*" OR "deficit DISORDER*" OR "depersonalization DISORDER*" OR "depersonalisation DISORDER*" OR "depressive DISORDER*" OR "developmental DISORDER*" OR "dissociative DISORDER*" OR "dysthymic DISORDER*" OR "emotional DISORDER*" OR "factitious DISORDER*" OR "mood DISORDER*" OR "obsessive-compulsive DISORDER*" OR "panic DISORDER*" OR "sleep DISORDER*" OR "depression" OR "depressive illness*" OR "anxiety" OR "anxieties" OR "anxious*" OR "agoraphobi*" OR "p hobia*" OR "phobic" OR "amnesia" OR "autism" OR "autistic" OR "bipolar" O R "bi-polar" OR "manic depressive" OR "mania" OR "bore* out" OR "boreout*" OR "brown* out" OR "brownout*" OR "burn* out" OR "burnout*" ) ) OR ( TITLE-ABS- KEY ( "neurodegenerative" W/1 ( "illness*" OR "disorder*" OR "disease*" ) ) ) OR ( TITLE-ABS- KEY ( ( "cognitive*" OR "cognition" OR "neurocognit*" OR "mental" ) W/3 ( "d eclin*" OR "dysfunction*" OR "impair*" OR "disorder*" OR "deteriorate*" OR "function" ) ) ) OR ( TITLE-ABS-KEY ( "health state utilit*" OR "utilities" OR "HSUV*" OR "addiction" OR "adhd" OR "attention deficit" OR "hyperactive" OR "aggression" OR "aggressive*" OR "aggressivity" OR "dement*" OR "amentia*" OR "senile" OR "senility" OR "presenile" OR "p resenility" OR "alzheimer*" ) ) OR ( TITLE-ABS- KEY ( "utility" W/3 ( "score*" OR "valu*" OR "health*" OR "cost*" OR "measu re*" OR "disease*" OR "mean" OR "gain" OR "gains" OR "index*" ) ) ) OR ( TI TLE-ABS-KEY ( ( "quality" W/2 "life" ) OR "quality adjusted Life" OR "QOL" OR "QALY" OR "QALYs" OR "HRQOL" OR "disability adjusted life" OR "DALY" OR "DALYS" ) ) OR ( TITLE-ABS- KEY ( ( ( "psychological*" OR "psychiatric" OR "psychotherapeutic" ) W/3 ( "imp act*" OR "outcome*" OR "effect*" OR "benefit*" OR "value*" ) ) OR ( "behavi o?r*" W/1 ( "disorder*" OR "illness*" OR "disease*" ) ) ) ) OR ( TITLE-ABS- KEY ( ( mental* OR psychological* OR psychiatric ) W/3 ( fatigue* OR disease* OR disorder* OR illness* OR diagnos* OR wellbeing OR wellbeing OR hygiene OR satisfy* OR stress* OR wellness* OR resilien* ) OR ( ( mental OR psychological OR psychiatric ) W/1 health ) OR ( wellbeing OR well -being OR mentally AND ill OR mentally AND unwell ) ) ) ) ) OR ( ( ( ( TITLE- ABS- KEY ( "water*" W/3 ( "expose*" OR "exposure*" OR "interact*" OR "proximity " OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( TITLE- ABS- KEY ( "water*" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "community" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "resid ential" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "water feature*" OR "water mirror*" OR ( "water*" W/3 "sound*" ) OR "water surface*" OR ( "water*" W/3 ( "body" OR "bodies" ) ) OR "water fall*" OR "waterfall*" OR "falling water*" OR "flowing water*" OR "water park*" OR "waterpark*" OR "water way*" OR "waterway*" OR "waterscape*" OR "waterscape*" OR "waterside*" OR "water side*" OR "water

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front*" OR "waterfront*" OR "water course*" OR "watercourse*" OR "watershed*" OR "water shed*" ) ) OR ( TITLE-ABS-KEY ( ( "sustainable" W/3 "drain*" ) OR "water- sensitive urban design*" ) ) OR ( TITLE-ABS- KEY ( "blue" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "c ommunity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "reside ntial" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "bluespace*" ) ) OR ( TITLE-ABS- KEY ( blue W/5 ( space* OR area* OR zone* OR corridor* OR connector* OR landscap* OR environment* OR architecture* OR infrastructure* OR design* ) ) ) ) OR ( TITLE-ABS- KEY ( "aquatic" OR "subaquatic" OR "beach" OR "beaches" OR "bog" OR "bog s" OR "canal" OR "canals" OR "coast" OR "coasts" OR "coastal" OR "creek*" OR "dock" OR "docks" OR "estuary" OR "estuaries" OR "fjord*" OR "flood plain*" OR "floodplain*" OR "fountain*" OR "harbor " OR "harbors" OR "harbour" OR "harbours" OR "hydrographic" OR "island*" OR "lagoon*" OR "lake" OR "lakes" OR "marina" OR "marinas" OR "marsh" OR "marshes" OR "marshland*" OR "ocean*" OR "pond*" OR "pool" OR "po ols" OR "port" OR "ports" OR "riparian" OR "river" OR "rivers" OR "riverside " OR "riverbank*" OR "riverfront*" OR "rockpool*" OR "rock pool*" OR "sea" OR "seas" OR "seashore*" OR "stream" OR "streams" OR " wetland*" OR "wet land*" ) ) ) AND ( TITLE ( "mental" OR "psychological" OR "wellbeing" OR "well being" OR "restoration" ) ) ) ) AND ( SRCTITLE ( "Landscape and Urban Planning" ) ) AND ( LIMIT-TO ( DOCTYPE , "ar" ) ) AND ( LIMIT- TO ( LANGUAGE , "English" ) ) View Less 1 SRCTITLE ( "Landscape and Urban Planning" ) 3,655 1 document

results 1 ( ( ( ABS ( ( "ocean*" OR "pond*" OR "pool" OR "pools" OR "port" OR "ports" 35,700 0 OR "riparian" OR "river" OR "rivers" OR "riverside" OR "riverbank*" OR "rive document rfront*" OR "rockpool*" OR "rock results pool*" OR "sea" OR "seas" OR "seashore*" OR "stream" OR "streams" OR " wetland*" OR "wet land*" ) W/3 ( "expose*" OR "exposure*" OR "interact*" OR "proximity" OR " vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( ABS ( ( "ocean* " OR "pond*" OR "pool" OR "pools" OR "port" OR "ports" OR "riparian" OR "river" OR "rivers" OR "riverside" OR "riverbank*" OR "riverfront*" OR "rockp ool*" OR "rock pool*" OR "sea" OR "seas" OR "seashore*" OR "stream" OR "streams" OR " wetland*" OR "wet land*" ) W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "com munity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "residentia l" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE ( "ocean *" OR "pond*" OR "pool" OR "pools" OR "port" OR "ports" OR "riparian" OR "river" OR "rivers" OR "riverside" OR "riverbank*" OR "riverfront*" OR "rock

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pool*" OR "rock pool*" OR "sea" OR "seas" OR "seashore*" OR "stream" OR "streams" OR " wetland*" OR "wet land*" ) ) OR ( ABS ( ( "harbOR" OR "harbors" OR "harbour" OR "harbours" OR "hYDrographic" OR "island*" OR "lagoon*" OR "lake" OR "lakes" OR "marina " OR "marinas" OR "marsh" OR "marshes" OR "marshland*" ) W/3 ( "expose* " OR "exposure*" OR "interact*" OR "proximity" OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( ABS ( ( "harbor" OR "harbors" OR "har bour" OR "harbours" OR "hydrographic" OR "island*" OR "lagoon*" OR "lake " OR "lakes" OR "marina" OR "marinas" OR "marsh" OR "marshes" OR "mars hland*" ) W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "co mmunity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" O R "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "residen tial" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE ( "har bor" OR "harbors" OR "harbour" OR "harbours" OR "hydrographic" OR "islan d*" OR "lagoon*" OR "lake" OR "lakes" OR "marina" OR "marinas" OR "mars h" OR "marshes" OR "marshland*" ) ) OR ( ABS ( ( "aquatic" OR "subaquatic" OR "beach" OR "beaches" OR "bog" OR "bogs" OR "canal" OR "canals" OR " coast" OR "coasts" OR "coastal" OR "creek*" OR "dock" OR "docks" OR "est uary" OR "estuaries" OR "fjord*" OR "flood plain*" OR "floodplain*" OR "fountain*" ) W/3 ( "expose*" OR "exposure*" O R "interact*" OR "proximity" OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( ABS ( ( "aquatic" OR "subaquatic" OR "beach" OR "beache s" OR "bog" OR "bogs" OR "brook" OR "brooks" OR "canal" OR "canals" OR "coast" OR "coasts" OR "coastal" OR "creek*" OR "dock" OR "docks" OR "est uary" OR "estuaries" OR "fjord*" OR "flood plain*" OR "floodplain*" OR "fountain*" ) W/5 ( "urban*" OR "neighbourhood *" OR "neighborhood*" OR "community" OR "communities" OR "city" OR "cit ies" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" O R "semisuburban" OR "residential" OR "municipal" OR "metropolitan" OR "m etropolis*" ) ) ) OR ( TITLE ( "aquatic" OR "subaquatic" OR "beach" OR "beache s" OR "bog" OR "bogs" OR "brook" OR "brooks" OR "canal" OR "canals" OR "coast" OR "coasts" OR "coastal" OR "creek*" OR "dock" OR "docks" OR "est uary" OR "estuaries" OR "fjord*" OR "flood plain*" OR "floodplain*" OR "fountain*" ) ) OR ( TITLE-ABS- KEY ( "water*" W/3 ( "expose*" OR "exposure*" OR "interact*" OR "proximity " OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( TITLE- ABS- KEY ( "water*" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "community" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "resid ential" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "water feature*" OR "water mirror*" OR ( "water*" W/3 "sound*" ) OR "water surface*" OR ( "water*" W/3 ( "body" OR "bodies" ) ) OR "water fall*" OR "waterfall*" OR "falling water*" OR "flowing water*" OR "water park*" OR "waterpark*" OR "water way*" OR "waterway*" OR "waterscape*" OR "waterscape*" OR "waterside*" OR "water side*" OR "water front*" OR "waterfront*" OR "water

EKLIPSE – Blue spaces and mental health and wellbeing 64 of 77

course*" OR "watercourse*" OR "watershed*" OR "water shed*" ) ) OR ( TITLE-ABS-KEY ( ( "sustainable" W/3 "drain*" ) OR "water- sensitive urban design*" ) ) OR ( TITLE-ABS- KEY ( "blue" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "c ommunity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "reside ntial" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "bluespace*" ) ) OR ( TITLE-ABS- KEY ( blue W/5 ( space* OR area* OR zone* OR corridor* OR connector* OR landscap* OR environment* OR architecture* OR infrastructure* OR design* ) ) ) ) AND ( ( TITLE-ABS- KEY ( "stress" W/3 ( "disorder*" OR "illness*" OR "trauma*" OR "posttrauma* " OR "acute" OR "chronic*" OR "episode*" OR "emotional" OR "occupational " OR "psychologic*" OR "recover*" OR "reduc*" ) ) ) OR ( TITLE-ABS- KEY ( "subjective wellbeing" OR "subjective wellbeing" OR "vitality" OR "paranoia" OR "psychosis" OR "psychotic" OR "schizo phreni*" OR "suicide*" OR "suicidal" OR salutogenetic* ) ) OR ( TITLE-ABS- KEY ( ( "belonging*" OR "coherence" ) W/3 "sense" ) ) OR ( TITLE-ABS- KEY ( "happiness" OR ( "peace" W/3 "mind" ) OR "serenity" OR "relaxing" OR "relaxation" OR "attention restoration" OR "restorative" OR "restorativeness" OR "insomnia" OR "insomn iac*" OR "sleep quality" OR "somatisation" OR "somatization" OR "somatoform" OR "mental aging" ) ) OR ( TITLE-ABS-KEY ( "emotional" W/3 ( "wellbeing" OR "wellbeing" OR "regulat*" ) ) ) OR ( TITLE-ABS-KEY ( "affective DISORDER*" OR "body dysmorphic DISORDER*" OR "cyclothymic DISORDER*" OR "deficit DISORDER*" OR "depersonalization DISORDER*" OR "depersonalisation DISORDER*" OR "depressive DISORDER*" OR "developmental DISORDER*" OR "dissociative DISORDER*" OR "dysthymic DISORDER*" OR "emotional DISORDER*" OR "factitious DISORDER*" OR "mood DISORDER*" OR "obsessive-compulsive DISORDER*" OR "panic DISORDER*" OR "sleep DISORDER*" OR "depression" OR "depressive illness*" OR "anxiety" OR "anxieties" OR "anxious*" OR "agoraphobi*" OR "p hobia*" OR "phobic" OR "amnesia" OR "autism" OR "autistic" OR "bipolar" O R "bi-polar" OR "manic depressive" OR "mania" OR "bore* out" OR "boreout*" OR "brown* out" OR "brownout*" OR "burn* out" OR "burnout*" ) ) OR ( TITLE-ABS- KEY ( "neurodegenerative" W/1 ( "illness*" OR "disorder*" OR "disease*" ) ) ) OR ( TITLE-ABS- KEY ( ( "cognitive*" OR "cognition" OR "neurocognit*" OR "mental" ) W/3 ( "d eclin*" OR "dysfunction*" OR "impair*" OR "disorder*" OR "deteriorate*" OR "function" ) ) ) OR ( TITLE-ABS-KEY ( "health state utilit*" OR "utilities" OR "HSUV*" OR "addiction" OR "adhd" OR "attention deficit" OR "hyperactive" OR "aggression" OR "aggressive*" OR "aggressivity" OR "dement*" OR "amentia*" OR "senile" OR "senility" OR "presenile" OR "p resenility" OR "alzheimer*" ) ) OR ( TITLE-ABS- KEY ( "utility" W/3 ( "score*" OR "valu*" OR "health*" OR "cost*" OR "measu re*" OR "disease*" OR "mean" OR "gain" OR "gains" OR "index*" ) ) ) OR ( TI TLE-ABS-KEY ( ( "quality" W/2 "life" ) OR "quality adjusted Life" OR "QOL" OR "QALY" OR "QALYs" OR "HRQOL" OR "disability adjusted

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life" OR "DALY" OR "DALYS" ) ) OR ( TITLE-ABS- KEY ( ( ( "psychological*" OR "psychiatric" OR "psychotherapeutic" ) W/3 ( "imp act*" OR "outcome*" OR "effect*" OR "benefit*" OR "value*" ) ) OR ( "behavi o?r*" W/1 ( "disorder*" OR "illness*" OR "disease*" ) ) ) ) OR ( TITLE-ABS- KEY ( ( mental* OR psychological* OR psychiatric ) W/3 ( fatigue* OR disease* OR disorder* OR illness* OR diagnos* OR wellbeing OR wellbeing OR hygiene OR satisfy* OR stress* OR wellness* OR resilien* ) OR ( ( mental OR psychological OR psychiatric ) W/1 health ) OR ( wellbeing OR well -being OR mentally AND ill OR mentally AND unwell ) ) ) ) ) OR ( ( ( ( TITLE- ABS- KEY ( "water*" W/3 ( "expose*" OR "exposure*" OR "interact*" OR "proximity " OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( TITLE- ABS- KEY ( "water*" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "community" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "resid ential" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "water feature*" OR "water mirror*" OR ( "water*" W/3 "sound*" ) OR "water surface*" OR ( "water*" W/3 ( "body" OR "bodies" ) ) OR "water fall*" OR "waterfall*" OR "falling water*" OR "flowing water*" OR "water park*" OR "waterpark*" OR "water way*" OR "waterway*" OR "waterscape*" OR "waterscape*" OR "waterside*" OR "water side*" OR "water front*" OR "waterfront*" OR "water course*" OR "watercourse*" OR "watershed*" OR "water shed*" ) ) OR ( TITLE-ABS-KEY ( ( "sustainable" W/3 "drain*" ) OR "water- sensitive urban design*" ) ) OR ( TITLE-ABS- KEY ( "blue" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "c ommunity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "reside ntial" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "bluespace*" ) ) OR ( TITLE-ABS- KEY ( blue W/5 ( space* OR area* OR zone* OR corridor* OR connector* OR landscap* OR environment* OR architecture* OR infrastructure* OR design* ) ) ) ) OR ( TITLE-ABS- KEY ( "aquatic" OR "subaquatic" OR "beach" OR "beaches" OR "bog" OR "bog s" OR "canal" OR "canals" OR "coast" OR "coasts" OR "coastal" OR "creek*" OR "dock" OR "docks" OR "estuary" OR "estuaries" OR "fjord*" OR "flood plain*" OR "floodplain*" OR "fountain*" OR "harbor " OR "harbors" OR "harbour" OR "harbours" OR "hydrographic" OR "island*" OR "lagoon*" OR "lake" OR "lakes" OR "marina" OR "marinas" OR "marsh" OR "marshes" OR "marshland*" OR "ocean*" OR "pond*" OR "pool" OR "po ols" OR "port" OR "ports" OR "riparian" OR "river" OR "rivers" OR "riverside " OR "riverbank*" OR "riverfront*" OR "rockpool*" OR "rock pool*" OR "sea" OR "seas" OR "seashore*" OR "stream" OR "streams" OR " wetland*" OR "wet land*" ) ) ) AND ( TITLE ( "mental" OR "psychological" OR "wellbeing" OR "well being" OR "restoration" ) ) ) AND ( LIMIT-TO ( DOCTYPE , "ar" ) ) AND ( LIMIT- TO ( LANGUAGE , "English" ) ) View Less

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9 ( ( ( ABS ( ( "ocean*" OR "pond*" OR "pool" OR "pools" OR "port" OR "ports" 51,746 OR "riparian" OR "river" OR "rivers" OR "riverside" OR "riverbank*" OR "rive document rfront*" OR "rockpool*" OR "rock results pool*" OR "sea" OR "seas" OR "seashore*" OR "stream" OR "streams" OR " wetland*" OR "wet land*" ) W/3 ( "expose*" OR "exposure*" OR "interact*" OR "proximity" OR " vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( ABS ( ( "ocean* " OR "pond*" OR "pool" OR "pools" OR "port" OR "ports" OR "riparian" OR "river" OR "rivers" OR "riverside" OR "riverbank*" OR "riverfront*" OR "rockp ool*" OR "rock pool*" OR "sea" OR "seas" OR "seashore*" OR "stream" OR "streams" OR " wetland*" OR "wet land*" ) W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "com munity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "residentia l" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE ( "ocean *" OR "pond*" OR "pool" OR "pools" OR "port" OR "ports" OR "riparian" OR "river" OR "rivers" OR "riverside" OR "riverbank*" OR "riverfront*" OR "rock pool*" OR "rock pool*" OR "sea" OR "seas" OR "seashore*" OR "stream" OR "streams" OR " wetland*" OR "wet land*" ) ) OR ( ABS ( ( "harbOR" OR "harbors" OR "harbour" OR "harbours" OR "hYDrographic" OR "island*" OR "lagoon*" OR "lake" OR "lakes" OR "marina " OR "marinas" OR "marsh" OR "marshes" OR "marshland*" ) W/3 ( "expose* " OR "exposure*" OR "interact*" OR "proximity" OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( ABS ( ( "harbor" OR "harbors" OR "har bour" OR "harbours" OR "hydrographic" OR "island*" OR "lagoon*" OR "lake " OR "lakes" OR "marina" OR "marinas" OR "marsh" OR "marshes" OR "mars hland*" ) W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "co mmunity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" O R "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "residen tial" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE ( "har bor" OR "harbors" OR "harbour" OR "harbours" OR "hydrographic" OR "islan d*" OR "lagoon*" OR "lake" OR "lakes" OR "marina" OR "marinas" OR "mars h" OR "marshes" OR "marshland*" ) ) OR ( ABS ( ( "aquatic" OR "subaquatic" OR "beach" OR "beaches" OR "bog" OR "bogs" OR "canal" OR "canals" OR " coast" OR "coasts" OR "coastal" OR "creek*" OR "dock" OR "docks" OR "est uary" OR "estuaries" OR "fjord*" OR "flood plain*" OR "floodplain*" OR "fountain*" ) W/3 ( "expose*" OR "exposure*" O R "interact*" OR "proximity" OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( ABS ( ( "aquatic" OR "subaquatic" OR "beach" OR "beache s" OR "bog" OR "bogs" OR "brook" OR "brooks" OR "canal" OR "canals" OR "coast" OR "coasts" OR "coastal" OR "creek*" OR "dock" OR "docks" OR "est uary" OR "estuaries" OR "fjord*" OR "flood plain*" OR "floodplain*" OR "fountain*" ) W/5 ( "urban*" OR "neighbourhood *" OR "neighborhood*" OR "community" OR "communities" OR "city" OR "cit ies" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" O R "semisuburban" OR "residential" OR "municipal" OR "metropolitan" OR "m etropolis*" ) ) ) OR ( TITLE ( "aquatic" OR "subaquatic" OR "beach" OR "beache s" OR "bog" OR "bogs" OR "brook" OR "brooks" OR "canal" OR "canals" OR

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"coast" OR "coasts" OR "coastal" OR "creek*" OR "dock" OR "docks" OR "est uary" OR "estuaries" OR "fjord*" OR "flood plain*" OR "floodplain*" OR "fountain*" ) ) OR ( TITLE-ABS- KEY ( "water*" W/3 ( "expose*" OR "exposure*" OR "interact*" OR "proximity " OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( TITLE- ABS- KEY ( "water*" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "community" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "resid ential" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "water feature*" OR "water mirror*" OR ( "water*" W/3 "sound*" ) OR "water surface*" OR ( "water*" W/3 ( "body" OR "bodies" ) ) OR "water fall*" OR "waterfall*" OR "falling water*" OR "flowing water*" OR "water park*" OR "waterpark*" OR "water way*" OR "waterway*" OR "waterscape*" OR "waterscape*" OR "waterside*" OR "water side*" OR "water front*" OR "waterfront*" OR "water course*" OR "watercourse*" OR "watershed*" OR "water shed*" ) ) OR ( TITLE-ABS-KEY ( ( "sustainable" W/3 "drain*" ) OR "water- sensitive urban design*" ) ) OR ( TITLE-ABS- KEY ( "blue" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "c ommunity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "reside ntial" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "bluespace*" ) ) OR ( TITLE-ABS- KEY ( blue W/5 ( space* OR area* OR zone* OR corridor* OR connector* OR landscap* OR environment* OR architecture* OR infrastructure* OR design* ) ) ) ) AND ( ( TITLE-ABS- KEY ( "stress" W/3 ( "disorder*" OR "illness*" OR "trauma*" OR "posttrauma* " OR "acute" OR "chronic*" OR "episode*" OR "emotional" OR "occupational " OR "psychologic*" OR "recover*" OR "reduc*" ) ) ) OR ( TITLE-ABS- KEY ( "subjective wellbeing" OR "subjective wellbeing" OR "vitality" OR "paranoia" OR "psychosis" OR "psychotic" OR "schizo phreni*" OR "suicide*" OR "suicidal" OR salutogenetic* ) ) OR ( TITLE-ABS- KEY ( ( "belonging*" OR "coherence" ) W/3 "sense" ) ) OR ( TITLE-ABS- KEY ( "happiness" OR ( "peace" W/3 "mind" ) OR "serenity" OR "relaxing" OR "relaxation" OR "attention restoration" OR "restorative" OR "restorativeness" OR "insomnia" OR "insomn iac*" OR "sleep quality" OR "somatisation" OR "somatization" OR "somatoform" OR "mental aging" ) ) OR ( TITLE-ABS-KEY ( "emotional" W/3 ( "wellbeing" OR "wellbeing" OR "regulat*" ) ) ) OR ( TITLE-ABS-KEY ( "affective DISORDER*" OR "body dysmorphic DISORDER*" OR "cyclothymic DISORDER*" OR "deficit DISORDER*" OR "depersonalization DISORDER*" OR "depersonalisation DISORDER*" OR "depressive DISORDER*" OR "developmental DISORDER*" OR "dissociative DISORDER*" OR "dysthymic DISORDER*" OR "emotional DISORDER*" OR "factitious DISORDER*" OR "mood DISORDER*" OR "obsessive-compulsive DISORDER*" OR "panic DISORDER*" OR "sleep DISORDER*" OR "depression" OR "depressive

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illness*" OR "anxiety" OR "anxieties" OR "anxious*" OR "agoraphobi*" OR "p hobia*" OR "phobic" OR "amnesia" OR "autism" OR "autistic" OR "bipolar" O R "bi-polar" OR "manic depressive" OR "mania" OR "bore* out" OR "boreout*" OR "brown* out" OR "brownout*" OR "burn* out" OR "burnout*" ) ) OR ( TITLE-ABS- KEY ( "neurodegenerative" W/1 ( "illness*" OR "disorder*" OR "disease*" ) ) ) OR ( TITLE-ABS- KEY ( ( "cognitive*" OR "cognition" OR "neurocognit*" OR "mental" ) W/3 ( "d eclin*" OR "dysfunction*" OR "impair*" OR "disorder*" OR "deteriorate*" OR "function" ) ) ) OR ( TITLE-ABS-KEY ( "health state utilit*" OR "utilities" OR "HSUV*" OR "addiction" OR "adhd" OR "attention deficit" OR "hyperactive" OR "aggression" OR "aggressive*" OR "aggressivity" OR "dement*" OR "amentia*" OR "senile" OR "senility" OR "presenile" OR "p resenility" OR "alzheimer*" ) ) OR ( TITLE-ABS- KEY ( "utility" W/3 ( "score*" OR "valu*" OR "health*" OR "cost*" OR "measu re*" OR "disease*" OR "mean" OR "gain" OR "gains" OR "index*" ) ) ) OR ( TI TLE-ABS-KEY ( ( "quality" W/2 "life" ) OR "quality adjusted Life" OR "QOL" OR "QALY" OR "QALYs" OR "HRQOL" OR "disability adjusted life" OR "DALY" OR "DALYS" ) ) OR ( TITLE-ABS- KEY ( ( ( "psychological*" OR "psychiatric" OR "psychotherapeutic" ) W/3 ( "imp act*" OR "outcome*" OR "effect*" OR "benefit*" OR "value*" ) ) OR ( "behavi o?r*" W/1 ( "disorder*" OR "illness*" OR "disease*" ) ) ) ) OR ( TITLE-ABS- KEY ( ( mental* OR psychological* OR psychiatric ) W/3 ( fatigue* OR disease* OR disorder* OR illness* OR diagnos* OR wellbeing OR wellbeing OR hygiene OR satisfy* OR stress* OR wellness* OR resilien* ) OR ( ( mental OR psychological OR psychiatric ) W/1 health ) OR ( wellbeing OR well -being OR mentally AND ill OR mentally AND unwell ) ) ) ) ) OR ( ( ( ( TITLE- ABS- KEY ( "water*" W/3 ( "expose*" OR "exposure*" OR "interact*" OR "proximity " OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( TITLE- ABS- KEY ( "water*" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "community" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "resid ential" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "water feature*" OR "water mirror*" OR ( "water*" W/3 "sound*" ) OR "water surface*" OR ( "water*" W/3 ( "body" OR "bodies" ) ) OR "water fall*" OR "waterfall*" OR "falling water*" OR "flowing water*" OR "water park*" OR "waterpark*" OR "water way*" OR "waterway*" OR "waterscape*" OR "waterscape*" OR "waterside*" OR "water side*" OR "water front*" OR "waterfront*" OR "water course*" OR "watercourse*" OR "watershed*" OR "water shed*" ) ) OR ( TITLE-ABS-KEY ( ( "sustainable" W/3 "drain*" ) OR "water- sensitive urban design*" ) ) OR ( TITLE-ABS- KEY ( "blue" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "c ommunity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "reside ntial" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE-

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ABS-KEY ( "bluespace*" ) ) OR ( TITLE-ABS- KEY ( blue W/5 ( space* OR area* OR zone* OR corridor* OR connector* OR landscap* OR environment* OR architecture* OR infrastructure* OR design* ) ) ) ) OR ( TITLE-ABS- KEY ( "aquatic" OR "subaquatic" OR "beach" OR "beaches" OR "bog" OR "bog s" OR "canal" OR "canals" OR "coast" OR "coasts" OR "coastal" OR "creek*" OR "dock" OR "docks" OR "estuary" OR "estuaries" OR "fjord*" OR "flood plain*" OR "floodplain*" OR "fountain*" OR "harbor " OR "harbors" OR "harbour" OR "harbours" OR "hydrographic" OR "island*" OR "lagoon*" OR "lake" OR "lakes" OR "marina" OR "marinas" OR "marsh" OR "marshes" OR "marshland*" OR "ocean*" OR "pond*" OR "pool" OR "po ols" OR "port" OR "ports" OR "riparian" OR "river" OR "rivers" OR "riverside " OR "riverbank*" OR "riverfront*" OR "rockpool*" OR "rock pool*" OR "sea" OR "seas" OR "seashore*" OR "stream" OR "streams" OR " wetland*" OR "wet land*" ) ) ) AND ( TITLE ( "mental" OR "psychological" OR "wellbeing" OR "well being" OR "restoration" ) ) ) View Less 8 ( ( ( TITLE-ABS- 12,838 KEY ( "water*" W/3 ( "expose*" OR "exposure*" OR "interact*" OR "proximity document " OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( TITLE- results ABS- KEY ( "water*" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "community" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "resid ential" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "water feature*" OR "water mirror*" OR ( "water*" W/3 "sound*" ) OR "water surface*" OR ( "water*" W/3 ( "body" OR "bodies" ) ) OR "water fall*" OR "waterfall*" OR "falling water*" OR "flowing water*" OR "water park*" OR "waterpark*" OR "water way*" OR "waterway*" OR "waterscape*" OR "waterscape*" OR "waterside*" OR "water side*" OR "water front*" OR "waterfront*" OR "water course*" OR "watercourse*" OR "watershed*" OR "water shed*" ) ) OR ( TITLE-ABS-KEY ( ( "sustainable" W/3 "drain*" ) OR "water- sensitive urban design*" ) ) OR ( TITLE-ABS- KEY ( "blue" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "c ommunity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "reside ntial" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "bluespace*" ) ) OR ( TITLE-ABS- KEY ( blue W/5 ( space* OR area* OR zone* OR corridor* OR connector* OR landscap* OR environment* OR architecture* OR infrastructure* OR design* ) ) ) ) OR ( TITLE-ABS- KEY ( "aquatic" OR "subaquatic" OR "beach" OR "beaches" OR "bog" OR "bog s" OR "canal" OR "canals" OR "coast" OR "coasts" OR "coastal" OR "creek*" OR "dock" OR "docks" OR "estuary" OR "estuaries" OR "fjord*" OR "flood plain*" OR "floodplain*" OR "fountain*" OR "harbor " OR "harbors" OR "harbour" OR "harbours" OR "hydrographic" OR "island*"

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OR "lagoon*" OR "lake" OR "lakes" OR "marina" OR "marinas" OR "marsh" OR "marshes" OR "marshland*" OR "ocean*" OR "pond*" OR "pool" OR "po ols" OR "port" OR "ports" OR "riparian" OR "river" OR "rivers" OR "riverside " OR "riverbank*" OR "riverfront*" OR "rockpool*" OR "rock pool*" OR "sea" OR "seas" OR "seashore*" OR "stream" OR "streams" OR " wetland*" OR "wet land*" ) ) ) AND ( TITLE ( "mental" OR "psychological" OR "wellbeing" OR "well being" OR "restoration" ) ) View Less 7 TITLE ( "mental" OR "psychological" OR "wellbeing" OR "well 308,614 being" OR "restoration" ) document

results 6 ( ( TITLE-ABS- 3,324,631 KEY ( "water*" W/3 ( "expose*" OR "exposure*" OR "interact*" OR "proximity document " OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( TITLE- results ABS- KEY ( "water*" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "community" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "resid ential" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "water feature*" OR "water mirror*" OR ( "water*" W/3 "sound*" ) OR "water surface*" OR ( "water*" W/3 ( "body" OR "bodies" ) ) OR "water fall*" OR "waterfall*" OR "falling water*" OR "flowing water*" OR "water park*" OR "waterpark*" OR "water way*" OR "waterway*" OR "waterscape*" OR "waterscape*" OR "waterside*" OR "water side*" OR "water front*" OR "waterfront*" OR "water course*" OR "watercourse*" OR "watershed*" OR "water shed*" ) ) OR ( TITLE-ABS-KEY ( ( "sustainable" W/3 "drain*" ) OR "water- sensitive urban design*" ) ) OR ( TITLE-ABS- KEY ( "blue" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "c ommunity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "reside ntial" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "bluespace*" ) ) OR ( TITLE-ABS- KEY ( blue W/5 ( space* OR area* OR zone* OR corridor* OR connector* OR landscap* OR environment* OR architecture* OR infrastructure* OR design* ) ) ) ) OR ( TITLE-ABS- KEY ( "aquatic" OR "subaquatic" OR "beach" OR "beaches" OR "bog" OR "bog s" OR "canal" OR "canals" OR "coast" OR "coasts" OR "coastal" OR "creek*" OR "dock" OR "docks" OR "estuary" OR "estuaries" OR "fjord*" OR "flood plain*" OR "floodplain*" OR "fountain*" OR "harbor " OR "harbors" OR "harbour" OR "harbours" OR "hydrographic" OR "island*" OR "lagoon*" OR "lake" OR "lakes" OR "marina" OR "marinas" OR "marsh" OR "marshes" OR "marshland*" OR "ocean*" OR "pond*" OR "pool" OR "po ols" OR "port" OR "ports" OR "riparian" OR "river" OR "rivers" OR "riverside " OR "riverbank*" OR "riverfront*" OR "rockpool*" OR "rock

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pool*" OR "sea" OR "seas" OR "seashore*" OR "stream" OR "streams" OR " wetland*" OR "wet land*" ) ) 4 ( TITLE-ABS- 342,160 KEY ( "water*" W/3 ( "expose*" OR "exposure*" OR "interact*" OR "proximity document " OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( TITLE- results ABS- KEY ( "water*" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "community" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "resid ential" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "water feature*" OR "water mirror*" OR ( "water*" W/3 "sound*" ) OR "water surface*" OR ( "water*" W/3 ( "body" OR "bodies" ) ) OR "water fall*" OR "waterfall*" OR "falling water*" OR "flowing water*" OR "water park*" OR "waterpark*" OR "water way*" OR "waterway*" OR "waterscape*" OR "waterscape*" OR "waterside*" OR "water side*" OR "water front*" OR "waterfront*" OR "water course*" OR "watercourse*" OR "watershed*" OR "water shed*" ) ) OR ( TITLE-ABS-KEY ( ( "sustainable" W/3 "drain*" ) OR "water- sensitive urban design*" ) ) OR ( TITLE-ABS- KEY ( "blue" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "c ommunity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "reside ntial" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "bluespace*" ) ) OR ( TITLE-ABS- KEY ( blue W/5 ( space* OR area* OR zone* OR corridor* OR connector* OR landscap* OR environment* OR architecture* OR infrastructure* OR design* ) ) ) 3 ( ( ABS ( ( "ocean*" OR "pond*" OR "pool" OR "pools" OR "port" OR "ports" 39,761 OR "riparian" OR "river" OR "rivers" OR "riverside" OR "riverbank*" OR "river document front*" OR "rockpool*" OR "rock results pool*" OR "sea" OR "seas" OR "seashore*" OR "stream" OR "streams" OR " wetland*" OR "wet land*" ) W/3 ( "expose*" OR "exposure*" OR "interact*" OR "proximity" OR " vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( ABS ( ( "ocean* " OR "pond*" OR "pool" OR "pools" OR "port" OR "ports" OR "riparian" OR "river" OR "rivers" OR "riverside" OR "riverbank*" OR "riverfront*" OR "rockp ool*" OR "rock pool*" OR "sea" OR "seas" OR "seashore*" OR "stream" OR "streams" OR " wetland*" OR "wet land*" ) W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "com munity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "residentia l" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE ( "ocean *" OR "pond*" OR "pool" OR "pools" OR "port" OR "ports" OR "riparian" OR "river" OR "rivers" OR "riverside" OR "riverbank*" OR "riverfront*" OR "rock pool*" OR "rock

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pool*" OR "sea" OR "seas" OR "seashore*" OR "stream" OR "streams" OR " wetland*" OR "wet land*" ) ) OR ( ABS ( ( "harbOR" OR "harbors" OR "harbour" OR "harbours" OR "hYDrographic" OR "island*" OR "lagoon*" OR "lake" OR "lakes" OR "marina " OR "marinas" OR "marsh" OR "marshes" OR "marshland*" ) W/3 ( "expose* " OR "exposure*" OR "interact*" OR "proximity" OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( ABS ( ( "harbor" OR "harbors" OR "har bour" OR "harbours" OR "hydrographic" OR "island*" OR "lagoon*" OR "lake " OR "lakes" OR "marina" OR "marinas" OR "marsh" OR "marshes" OR "mars hland*" ) W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "co mmunity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" O R "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "residen tial" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE ( "har bor" OR "harbors" OR "harbour" OR "harbours" OR "hydrographic" OR "islan d*" OR "lagoon*" OR "lake" OR "lakes" OR "marina" OR "marinas" OR "mars h" OR "marshes" OR "marshland*" ) ) OR ( ABS ( ( "aquatic" OR "subaquatic" OR "beach" OR "beaches" OR "bog" OR "bogs" OR "canal" OR "canals" OR " coast" OR "coasts" OR "coastal" OR "creek*" OR "dock" OR "docks" OR "est uary" OR "estuaries" OR "fjord*" OR "flood plain*" OR "floodplain*" OR "fountain*" ) W/3 ( "expose*" OR "exposure*" O R "interact*" OR "proximity" OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( ABS ( ( "aquatic" OR "subaquatic" OR "beach" OR "beache s" OR "bog" OR "bogs" OR "brook" OR "brooks" OR "canal" OR "canals" OR "coast" OR "coasts" OR "coastal" OR "creek*" OR "dock" OR "docks" OR "est uary" OR "estuaries" OR "fjord*" OR "flood plain*" OR "floodplain*" OR "fountain*" ) W/5 ( "urban*" OR "neighbourhood *" OR "neighborhood*" OR "community" OR "communities" OR "city" OR "cit ies" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" O R "semisuburban" OR "residential" OR "municipal" OR "metropolitan" OR "m etropolis*" ) ) ) OR ( TITLE ( "aquatic" OR "subaquatic" OR "beach" OR "beache s" OR "bog" OR "bogs" OR "brook" OR "brooks" OR "canal" OR "canals" OR "coast" OR "coasts" OR "coastal" OR "creek*" OR "dock" OR "docks" OR "est uary" OR "estuaries" OR "fjord*" OR "flood plain*" OR "floodplain*" OR "fountain*" ) ) OR ( TITLE-ABS- KEY ( "water*" W/3 ( "expose*" OR "exposure*" OR "interact*" OR "proximity " OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( TITLE- ABS- KEY ( "water*" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "community" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "resid ential" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "water feature*" OR "water mirror*" OR ( "water*" W/3 "sound*" ) OR "water surface*" OR ( "water*" W/3 ( "body" OR "bodies" ) ) OR "water fall*" OR "waterfall*" OR "falling water*" OR "flowing water*" OR "water park*" OR "waterpark*" OR "water way*" OR "waterway*" OR "waterscape*" OR "waterscape*" OR "waterside*" OR "water side*" OR "water front*" OR "waterfront*" OR "water course*" OR "watercourse*" OR "watershed*" OR "water

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shed*" ) ) OR ( TITLE-ABS-KEY ( ( "sustainable" W/3 "drain*" ) OR "water- sensitive urban design*" ) ) OR ( TITLE-ABS- KEY ( "blue" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "c ommunity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "reside ntial" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "bluespace*" ) ) OR ( TITLE-ABS- KEY ( blue W/5 ( space* OR area* OR zone* OR corridor* OR connector* OR landscap* OR environment* OR architecture* OR infrastructure* OR design* ) ) ) ) AND ( ( TITLE-ABS- KEY ( "stress" W/3 ( "disorder*" OR "illness*" OR "trauma*" OR "posttrauma* " OR "acute" OR "chronic*" OR "episode*" OR "emotional" OR "occupational " OR "psychologic*" OR "recover*" OR "reduc*" ) ) ) OR ( TITLE-ABS- KEY ( "subjective wellbeing" OR "subjective wellbeing" OR "vitality" OR "paranoia" OR "psychosis" OR "psychotic" OR "schizo phreni*" OR "suicide*" OR "suicidal" OR salutogenetic* ) ) OR ( TITLE-ABS- KEY ( ( "belonging*" OR "coherence" ) W/3 "sense" ) ) OR ( TITLE-ABS- KEY ( "happiness" OR ( "peace" W/3 "mind" ) OR "serenity" OR "relaxing" OR "relaxation" OR "attention restoration" OR "restorative" OR "restorativeness" OR "insomnia" OR "insomn iac*" OR "sleep quality" OR "somatisation" OR "somatization" OR "somatoform" OR "mental aging" ) ) OR ( TITLE-ABS-KEY ( "emotional" W/3 ( "wellbeing" OR "wellbeing" OR "regulat*" ) ) ) OR ( TITLE-ABS-KEY ( "affective DISORDER*" OR "body dysmorphic DISORDER*" OR "cyclothymic DISORDER*" OR "deficit DISORDER*" OR "depersonalization DISORDER*" OR "depersonalisation DISORDER*" OR "depressive DISORDER*" OR "developmental DISORDER*" OR "dissociative DISORDER*" OR "dysthymic DISORDER*" OR "emotional DISORDER*" OR "factitious DISORDER*" OR "mood DISORDER*" OR "obsessive-compulsive DISORDER*" OR "panic DISORDER*" OR "sleep DISORDER*" OR "depression" OR "depressive illness*" OR "anxiety" OR "anxieties" OR "anxious*" OR "agoraphobi*" OR "p hobia*" OR "phobic" OR "amnesia" OR "autism" OR "autistic" OR "bipolar" O R "bi-polar" OR "manic depressive" OR "mania" OR "bore* out" OR "boreout*" OR "brown* out" OR "brownout*" OR "burn* out" OR "burnout*" ) ) OR ( TITLE-ABS- KEY ( "neurodegenerative" W/1 ( "illness*" OR "disorder*" OR "disease*" ) ) ) OR ( TITLE-ABS- KEY ( ( "cognitive*" OR "cognition" OR "neurocognit*" OR "mental" ) W/3 ( "d eclin*" OR "dysfunction*" OR "impair*" OR "disorder*" OR "deteriorate*" OR "function" ) ) ) OR ( TITLE-ABS-KEY ( "health state utilit*" OR "utilities" OR "HSUV*" OR "addiction" OR "adhd" OR "attention deficit" OR "hyperactive" OR "aggression" OR "aggressive*" OR "aggressivity" OR "dement*" OR "amentia*" OR "senile" OR "senility" OR "presenile" OR "p resenility" OR "alzheimer*" ) ) OR ( TITLE-ABS- KEY ( "utility" W/3 ( "score*" OR "valu*" OR "health*" OR "cost*" OR "measu re*" OR "disease*" OR "mean" OR "gain" OR "gains" OR "index*" ) ) ) OR ( TI TLE-ABS-KEY ( ( "quality" W/2 "life" ) OR "quality adjusted Life" OR "QOL" OR "QALY" OR "QALYs" OR "HRQOL" OR "disability adjusted life" OR "DALY" OR "DALYS" ) ) OR ( TITLE-ABS-

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KEY ( ( ( "psychological*" OR "psychiatric" OR "psychotherapeutic" ) W/3 ( "imp act*" OR "outcome*" OR "effect*" OR "benefit*" OR "value*" ) ) OR ( "behavi o?r*" W/1 ( "disorder*" OR "illness*" OR "disease*" ) ) ) ) OR ( TITLE-ABS- KEY ( ( mental* OR psychological* OR psychiatric ) W/3 ( fatigue* OR disease* OR disorder* OR illness* OR diagnos* OR wellbeing OR wellbeing OR hygiene OR satisfy* OR stress* OR wellness* OR resilien* ) OR ( ( mental OR psychological OR psychiatric ) W/1 health ) OR ( wellbeing OR well -being OR mentally AND ill OR mentally AND unwell ) ) ) ) 2 ( TITLE-ABS- 4,226,965 KEY ( "stress" W/3 ( "disorder*" OR "illness*" OR "trauma*" OR "posttrauma* document " OR "acute" OR "chronic*" OR "episode*" OR "emotional" OR "occupational results " OR "psychologic*" OR "recover*" OR "reduc*" ) ) ) OR ( TITLE-ABS- KEY ( "subjective wellbeing" OR "subjective wellbeing" OR "vitality" OR "paranoia" OR "psychosis" OR "psychotic" OR "schizo phreni*" OR "suicide*" OR "suicidal" OR salutogenetic* ) ) OR ( TITLE-ABS- KEY ( ( "belonging*" OR "coherence" ) W/3 "sense" ) ) OR ( TITLE-ABS- KEY ( "happiness" OR ( "peace" W/3 "mind" ) OR "serenity" OR "relaxing" OR "relaxation" OR "attention restoration" OR "restorative" OR "restorativeness" OR "insomnia" OR "insomn iac*" OR "sleep quality" OR "somatisation" OR "somatization" OR "somatoform" OR "mental aging" ) ) OR ( TITLE-ABS-KEY ( "emotional" W/3 ( "wellbeing" OR "wellbeing" OR "regulat*" ) ) ) OR ( TITLE-ABS-KEY ( "affective DISORDER*" OR "body dysmorphic DISORDER*" OR "cyclothymic DISORDER*" OR "deficit DISORDER*" OR "depersonalization DISORDER*" OR "depersonalisation DISORDER*" OR "depressive DISORDER*" OR "developmental DISORDER*" OR "dissociative DISORDER*" OR "dysthymic DISORDER*" OR "emotional DISORDER*" OR "factitious DISORDER*" OR "mood DISORDER*" OR "obsessive-compulsive DISORDER*" OR "panic DISORDER*" OR "sleep DISORDER*" OR "depression" OR "depressive illness*" OR "anxiety" OR "anxieties" OR "anxious*" OR "agoraphobi*" OR "p hobia*" OR "phobic" OR "amnesia" OR "autism" OR "autistic" OR "bipolar" O R "bi-polar" OR "manic depressive" OR "mania" OR "bore* out" OR "boreout*" OR "brown* out" OR "brownout*" OR "burn* out" OR "burnout*" ) ) OR ( TITLE-ABS- KEY ( "neurodegenerative" W/1 ( "illness*" OR "disorder*" OR "disease*" ) ) ) OR ( TITLE-ABS- KEY ( ( "cognitive*" OR "cognition" OR "neurocognit*" OR "mental" ) W/3 ( "d eclin*" OR "dysfunction*" OR "impair*" OR "disorder*" OR "deteriorate*" OR "function" ) ) ) OR ( TITLE-ABS-KEY ( "health state utilit*" OR "utilities" OR "HSUV*" OR "addiction" OR "adhd" OR "attention deficit" OR "hyperactive" OR "aggression" OR "aggressive*" OR "aggressivity" OR "dement*" OR "amentia*" OR "senile" OR "senility" OR "presenile" OR "p resenility" OR "alzheimer*" ) ) OR ( TITLE-ABS- KEY ( "utility" W/3 ( "score*" OR "valu*" OR "health*" OR "cost*" OR "measu re*" OR "disease*" OR "mean" OR "gain" OR "gains" OR "index*" ) ) ) OR ( TI TLE-ABS-KEY ( ( "quality" W/2 "life" ) OR "quality adjusted Life" OR "QOL" OR "QALY" OR "QALYs" OR "HRQOL" OR "disability adjusted life" OR "DALY" OR "DALYS" ) ) OR ( TITLE-ABS-

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KEY ( ( ( "psychological*" OR "psychiatric" OR "psychotherapeutic" ) W/3 ( "imp act*" OR "outcome*" OR "effect*" OR "benefit*" OR "value*" ) ) OR ( "behavi o?r*" W/1 ( "disorder*" OR "illness*" OR "disease*" ) ) ) ) OR ( TITLE-ABS- KEY ( ( mental* OR psychological* OR psychiatric ) W/3 ( fatigue* OR disease* OR disorder* OR illness* OR diagnos* OR wellbeing OR wellbeing OR hygiene OR satisfy* OR stress* OR wellness* OR resilien* ) OR ( ( mental OR psychological OR psychiatric ) W/1 health ) OR ( wellbeing OR well -being OR mentally AND ill OR mentally AND unwell ) ) ) 1 ( ABS ( ( "ocean*" OR "pond*" OR "pool" OR "pools" OR "port" OR "ports" O 1,387,219 R "riparian" OR "river" OR "rivers" OR "riverside" OR "riverbank*" OR "riverfr document ont*" OR "rockpool*" OR "rock results pool*" OR "sea" OR "seas" OR "seashore*" OR "stream" OR "streams" OR " wetland*" OR "wet land*" ) W/3 ( "expose*" OR "exposure*" OR "interact*" OR "proximity" OR " vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( ABS ( ( "ocean* " OR "pond*" OR "pool" OR "pools" OR "port" OR "ports" OR "riparian" OR "river" OR "rivers" OR "riverside" OR "riverbank*" OR "riverfront*" OR "rockp ool*" OR "rock pool*" OR "sea" OR "seas" OR "seashore*" OR "stream" OR "streams" OR " wetland*" OR "wet land*" ) W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "com munity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "residentia l" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE ( "ocean *" OR "pond*" OR "pool" OR "pools" OR "port" OR "ports" OR "riparian" OR "river" OR "rivers" OR "riverside" OR "riverbank*" OR "riverfront*" OR "rock pool*" OR "rock pool*" OR "sea" OR "seas" OR "seashore*" OR "stream" OR "streams" OR " wetland*" OR "wet land*" ) ) OR ( ABS ( ( "harbOR" OR "harbors" OR "harbour" OR "harbours" OR "hYDrographic" OR "island*" OR "lagoon*" OR "lake" OR "lakes" OR "marina " OR "marinas" OR "marsh" OR "marshes" OR "marshland*" ) W/3 ( "expose* " OR "exposure*" OR "interact*" OR "proximity" OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( ABS ( ( "harbor" OR "harbors" OR "har bour" OR "harbours" OR "hydrographic" OR "island*" OR "lagoon*" OR "lake " OR "lakes" OR "marina" OR "marinas" OR "marsh" OR "marshes" OR "mars hland*" ) W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "co mmunity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" O R "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "residen tial" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE ( "har bor" OR "harbors" OR "harbour" OR "harbours" OR "hydrographic" OR "islan d*" OR "lagoon*" OR "lake" OR "lakes" OR "marina" OR "marinas" OR "mars h" OR "marshes" OR "marshland*" ) ) OR ( ABS ( ( "aquatic" OR "subaquatic" OR "beach" OR "beaches" OR "bog" OR "bogs" OR "canal" OR "canals" OR " coast" OR "coasts" OR "coastal" OR "creek*" OR "dock" OR "docks" OR "est uary" OR "estuaries" OR "fjord*" OR "flood plain*" OR "floodplain*" OR "fountain*" ) W/3 ( "expose*" OR "exposure*" O R "interact*" OR "proximity" OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( ABS ( ( "aquatic" OR "subaquatic" OR "beach" OR "beache

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s" OR "bog" OR "bogs" OR "brook" OR "brooks" OR "canal" OR "canals" OR "coast" OR "coasts" OR "coastal" OR "creek*" OR "dock" OR "docks" OR "est uary" OR "estuaries" OR "fjord*" OR "flood plain*" OR "floodplain*" OR "fountain*" ) W/5 ( "urban*" OR "neighbourhood *" OR "neighborhood*" OR "community" OR "communities" OR "city" OR "cit ies" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" O R "semisuburban" OR "residential" OR "municipal" OR "metropolitan" OR "m etropolis*" ) ) ) OR ( TITLE ( "aquatic" OR "subaquatic" OR "beach" OR "beache s" OR "bog" OR "bogs" OR "brook" OR "brooks" OR "canal" OR "canals" OR "coast" OR "coasts" OR "coastal" OR "creek*" OR "dock" OR "docks" OR "est uary" OR "estuaries" OR "fjord*" OR "flood plain*" OR "floodplain*" OR "fountain*" ) ) OR ( TITLE-ABS- KEY ( "water*" W/3 ( "expose*" OR "exposure*" OR "interact*" OR "proximity " OR "vicinity" OR "vicinities" OR "distance*" OR "location*" ) ) ) OR ( TITLE- ABS- KEY ( "water*" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "community" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "resid ential" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "water feature*" OR "water mirror*" OR ( "water*" W/3 "sound*" ) OR "water surface*" OR ( "water*" W/3 ( "body" OR "bodies" ) ) OR "water fall*" OR "waterfall*" OR "falling water*" OR "flowing water*" OR "water park*" OR "waterpark*" OR "water way*" OR "waterway*" OR "waterscape*" OR "waterscape*" OR "waterside*" OR "water side*" OR "water front*" OR "waterfront*" OR "water course*" OR "watercourse*" OR "watershed*" OR "water shed*" ) ) OR ( TITLE-ABS-KEY ( ( "sustainable" W/3 "drain*" ) OR "water- sensitive urban design*" ) ) OR ( TITLE-ABS- KEY ( "blue" W/5 ( "urban*" OR "neighbourhood*" OR "neighborhood*" OR "c ommunity" OR "communities" OR "city" OR "cities" OR "town" OR "towns" OR "suburb*" OR "semiurban" OR "periurban" OR "semisuburban" OR "reside ntial" OR "municipal" OR "metropolitan" OR "metropolis*" ) ) ) OR ( TITLE- ABS-KEY ( "bluespace*" ) ) OR ( TITLE-ABS- KEY ( blue W/5 ( space* OR area* OR zone* OR corridor* OR connector* OR landscap* OR environment* OR architecture* OR infrastructure* OR design* ) ) ) 1

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